HO Supplier Switch Form

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
New Supplier*
What does the member use heating oil for?*
Where is the tank located?*
Where is the fill spout located?*
Tank Size*
A standard sized tank is 275 gallons which is typical for a residential home. Enter "Unknown" if the member doesn't know.
Delivery Notes
Enter any special notes the member provides related to oil delivery.
When does the member plan to place their first order?
MM slash DD slash YYYY
Are you interested in hearing about service contract options from the supplier?*
- Yes
- No
Date Member Requested Switch*
MM slash DD slash YYYY
Supplier Switch Received By*