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Application to Join the NJCA Oil Group

Joining is easy! There are four ways to submit your NJCA Oil Group application:

  1. Apply online using the Application form below. Please fill in all of the blanks. *Required information is marked with an asterisk* When you are finished, press the 'send' button at the end of the form.

  2. Apply by mail. Print out a copy of the Application form, complete it and send to:

    NJCAOG
    2 Riverside Drive, Suite 632
    Camden, NJ 08103

  3. Apply by phone by calling 1-800-464-8465 and the NJCAOG staff will take your application over the phone.

  4. Apply by fax. Print the form and fax your completed application to 856-966-3099.

  5. Once you become a Member... you have the opportunity to earn $20 for every friend you refer who joins and uses the Oil Group. The more you refer, the more you earn! Simply tell your friends, family, neighbors and co-workers, who heat their homes with oil, to sign up and reference your name on the application. Everyone wins — you receive a check for $20 and your friends save hundreds of dollars while enjoying the benefits of a full service oil company. Plus, more members mean more bargaining power for us to keep prices down!
Application Form

Tell Us About Yourself  (* Required information)
*Applicant's Name
*Date of Birth

This information is for our office use only. We need to know your date of birth in order to potentially provide you with our "Senior" membership rate.
Email Address


Delivery Address
 
*Street
*City
*Zip
*County
*Do you own or rent the property? (If rent, give landlord's name & address)


Billing Address If Different
 
Street
City
Zip
County
*Do you own or rent the property? (If rent, give landlord's name & address)
*Name of current oil company

We will not attempt to contact your current supplier in any way. We need to know if you are currently using one of our suppliers. If this is the case, we will place you with them for your convenience unless otherwise requested by you.
*How did you hear about us?
*Home (or primary) phone with area code

We need at least one phone number to reach you — please enter it here. Additional phone numbers can be given below.
Work phone with area code
Cell phone with area code

Additional Information
Last Delivery Date
*Tank Size

Standard tank sizes are usually 275 gallons, 500 gallons or 1,000 gallons.
Annual Fuel Consumption
*Do you use oil to heat your hot water? Yes or No
Are you interested in a service plan? Yes or No
Are you interested in tank coverage? Yes or No
*Is your oil tank located: Above Ground, Under Ground, or Inside?
*Where is your fill pipe located?

Help Us Match Your Needs to Our Suppliers
*Delivery Options: Automatic Fill or Will Call?(select one)


Automatic Fill: The dealer monitors your usage and automatically fills your tank when you are running low.
Will Call: You call the dealer for a delivery when you want oil.
*Payment Options: 20 Day Billing, Budget Billing or COD? (select one)


20 Day Billing: The dealer makes a delivery and then you have 20 or 30 days to make a payment in full.
Budget Billing: The dealer spreads your payments out evenly over the course of a year.
COD: Cash on delivery.
*Bio-Fuel or Standard Heating Oil?

If you live in any of the following counties, you may have the option of using bio-fuel: Bergen, Essex, Hudson, Middlesex, Morris, Passaic, Somerset, Sussex, Union. Please indicate your preference below.

By my signature below, I certify that all information provided in this application is true and complete. I understand and agree that New Jersey Citizen Action Oil Group (NJCAOG) is not a dealer, broker, supplier, provider, or distributor of heating oil or petroleum products, nor does NJCAOG provide, sell, service, maintain, or install heating or cooling equipment. I understand that NJCAOG is not responsible for any acts or omissions of heating oil suppliers, service suppliers, or equipment manufacturers/distributor/providers and I agree to hold NJCAOG harmless for any loss of whatever nature I may suffer due to the actions or inactions of any party, whether or not NJCAOG assigned me for purposes of supply of home heating oil, related services, or equipment. I agree to notify NJCAOG in writing no less than thirty (30) days in advance of conversion of my heating equipment from oil to natural or LP gas, if I move to another location, or decide to withdraw from membership in NJCAOG. I understand that membership dues are billed annually and that members who fail to renew will not receive the benefits of the NJCAOG member discounts. THE MEMBERSHIP FEE IS NOT DEDUCTIBLE OR REFUNDABLE.
*Signature (type in)


Yearly Fee Schedule (Place an X by all that apply — but you MUST SELECT at least one category)
$30.00 individual households
$15.00 senior citizens (60+)
$35.00 commercial organizations
$6.00 each additional delivery address


Payment
*Payment Type: Check, Money Order, Visa, MasterCard or Discover (list one)

If you are mailing a check or money order, please note that your Oil Group rate will not go into effect until we have received your membership payment.
If paying by check or MO, please make payable to NJCAOG and mail, along with completed application, to NJCAOG, 2 Riverside Drive, Suite 632, Camden, NJ 08103.
Credit Card Type
Credit Card Number
Credit Card Expiration Date


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updated july 9, 2010