return
order
Please understand we do not work on a fixed schedule. Your
delivery could be made as early as the same hour and as long
as 3-4 business days. Please plan accordingly.
Account #
A
ccount #1055 is a generic account used for first time
customers. You are not eligible to use this form.
First Name
Last Name
Phone
p
lease confirm email
address
Order Amount
GALLONS
$$$
100 gallon minimum
Please confirm
today's price
THERE ARE TWO PRICES. YOU MUST ORDER 150
GALLONS OR MORE FOR THE LOWER PRICE.
Current Tank Level
EMPTY
1/8 FULL
1/4 FULL
1/2 FULL
5/8 FULL
3/4 FULL
We do not accept cash
payments. We do not
accept credit cards.
Payment
CHECK
MONEY ORDER
Please detail where your
payment will be LEFT
OUT IMMEDIATELY.
Please agree to the terms of service.
Payments will be left out immediately
upon submitting an order and before
receiving a confirmation from Clean Oil.
Missed deliverys will incur a $50 delivery
charge.
Yes I agree to the terms of service.
*****HAVE YOUR PAYMENT OUT IMMEDIATELY AND LEFT OUT
UNTIL THE DELIVERY.
Please do not place your order without having your payment out.
Comments
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LEASE MAKE CHECKS
PAYBLE TO CLEAN OIL OR
ORDERCLEANOIL.COM