Tell Us About Yourself |
Applicant's Name |
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Date of Birth |
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Email Address |
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Delivery Address |
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Street |
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City |
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Zip |
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County |
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Do you own or rent the property? (If rent, give landlord's name & address) |
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Billing Address If Different |
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Street |
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City |
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Zip |
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County |
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Do you own or rent the property? (If rent, give landlord's name & address) |
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Name of current oil company |
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How did you hear about us? |
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Home phone with area code |
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Work phone with area code |
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Cell phone with area code |
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Additional Information |
Last Delivery Date |
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Tank Size |
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Annual Fuel Consumption |
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Do you use oil to heat your hot water? Yes or No |
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Are you interested in a service plan? Yes or No |
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Are you interested in tank coverage? Yes or No |
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Is your oil tank located: Inside, Outside or Underground? |
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To receive a discount, I understand that I must pay my supplier on time. I understand that membership dues are billed annually and my failure to renew those dues within 30 days of billing will result in the termination of Oil Group prices. I agree to notify NJCAOG in writing of my intent to convert my home's fuel source, move to another residence, and/or to withdraw from the group within 30 days of discontinuance. I understand membership dues are non-refundable. |
Signature |
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Yearly Fee Schedule (Place an X by all that apply) |
$30.00 individual households |
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$15.00 senior citizens (60+) |
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$35.00 commercial organizations |
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$6.00 each additional delivery address |
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Payment |
Payment Type: Check, Money Order, Visa, MasterCard or Discover (list one) |
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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 07103. |
Credit Card Type |
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Credit Card Number |
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Credit Card Expiration Date |
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Application