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Refer A Friend

MacLellan Oil welcomes new customers. If you would like to experience the peace of mind of having a reliable supplier that provides attentive, proactive service, please fill out the form below.

* = Required Field

Basic Information:

* Applicant's Name:
(first, mi, last)
Mr.   Ms.   Mrs.

* Email:

* Social Security #:
Co-Applicant's Name:
(first, mi, last)
Mr.   Ms.   Mrs.

Social Security #:

* Home Phone Number:
( - 
* Billing Address:
(City, State ZIP)

How Long Have You Been
At This Address?

* Own or Rent?
Own  Rent
* Delivery Address:
(City, State ZIP)
Same as billing address.

Mortgage Bank / Landlord:
Full Address:
(City, State ZIP)

Phone Number:

( - 
Previous Address:
(If less than 4 years
at current address)

(City, State ZIP)


Employment Information

* Applicant's Employment:

(City, State ZIP)

Phone Number:
( - 
Years With Company:

Applicant's Previous Employer:
(If less than 1 year at present)
(City, State ZIP)

Co-Applicant's Employment:

(City, State ZIP)

Phone Number:
( - 
Years With Company:

Credit References

* Bank:

Account #:
Account Type:

( - 

Savings  Checking
* Name on Credit Card:
Account Number:
Expiration Date:


Emergency Contact

* Name:
(Relative or friend not living with you)

* Address:
(City, State ZIP)

* Phone Number:
( - 

Delivery Information

* Fill Pipe Location:
left side
back of house
Fill Pipe Location
front of house
right side
* Tank Size:
275 gallons
330 gallons
550 gallons
1,000 gallons
Vent Alarm:
Yes  No 
Nearest Street:

Delivery Instructions:

Estimated Gallons in Tank:
10-30 gallons
30-50 gallons
50-70 gallons
70-90 gallons
90+ gallons
Do You Have a Budget Plan?
Yes  No
Type of Heat:

Do You Have a Burner
Service Plan?

Yes  No
* Previous Supplier

Terms & Conditions

All information provided above is true to the best of my/our knowledge. You have my permission to verify any of the above information. If credit is hereby granted, I/we agree to pay the account in full within the thirty (30) day credit terms. A finance charge of 1 1/2 % per month (annual percentage of 18%) will be assessed on all accounts unpaid in thirty (30) days following the due date. Non compliance with credit terms may result in the disruption and/or termination of fuel oil deliveries.

I Have Read and Agree to the Credit Terms Above
* Applicant's Signature:  Date:
Co-Applicant's Signature:  Date:

Please click the checkbox below to verify:

Oilheat America MEMA NORA
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