Please complete the information below or if you prefer, download a pdf of our application to mail or drop off at your local Fred’s Energy office.

download & print paper application

    Customer Information


    Social Security Number*


    Mailing Address (including Town, State & Zip)*

    Home Phone*



    Employer Phone*

    Do you Own or Rent*

    If rent, what is your Landlord's name

    If property is used for rental income, do you rent
    long-term or short-term (week-to-week/vacation)

    Delivery Information

    Delivery Address (if different from mailing address)

    Product Type

    Tank Size

    Fuel Tank Fill Pipe Location

    Delivery Instructions

    Previous fuel oil or propane supplier

    With credit approval, automatic delivery service is available. Please check method of delivery:

    How did you hear of us?

    Do you reside at this location during winter months?

    Do you heat your water with oil?

    Do you heat your water with propane?

    Do you burn wood?

    By submitting this application, I/we agree to a credit check.

    *Required information