New Customermyvivalahemp00052024-07-18T07:07:21+00:00 Name Of Stop Delivery Address New Customer Information County Phone A/P & Contact Name Fax Tank Charts Yes No Your Email After Hours / Emergency Cell # & Contact Size of tank Number of tanks If below GRD: Steel/Fiber Glass Below Ground / Above Ground Tank(need underground storage certificate if below GRD) Billing Address Is voucher needed for Payment? Yes No If voucher needed please upload or fax(973-546-0126) Product Gas Regular Gas Plus Premium ULSD Clear Dyed Heating Oil Select one Gravity Meter Delivery Federal ID #/Tax Exempt # (must get form 6416 Cert for IRS!) Location of tank Times we can deliver Supervisor to see at time of delivery Put on schedule Yes No If yes,How often? Send
