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.COD : Cash on delivery.
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.
Bio-Fuel Standard Heating Oil
Do you need oil immediately? Check the box
Yes! I need oil immediately.
Your Comments
Yearly Membership
*Payment Type (MUST select one of the three options)
Check Money Order
If paying by Check or Money Order ,
please make payable to NJCAOG and mail it along with a printout of the completed application form (THIS PAGE) to: NJCAOG,
1040 Kings Highway � Suite 308,
Cherry Hill, NJ 08034.
$30.00 individual household $20.00 senior citizens (60+) $35.00 commercial organization $6.00 each additional delivery address
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)
Date
If you are paying by Check or Money Order, please *PRINT OUT* THIS COMPLETED PAGE *NOW* before proceeding to STEP TWO, and please include a copy along with your Check or Money Order.
1-800-464-8465 .
