Commercial Delivery Request Form

This form is to request delivery of fuel oil, kerosene or propane for our current commercial customers.

If you would like to start an account with us, please fill out our Commercial Fueling Credit Application and send the filled out document to our email commercialfueling@qocnc.com

Please note: Our hours of operation are Monday-Friday from 8:00 am to 5:00 pm.

Requests after normal operating hours will be handled the next business day. For emergency after hours delivery, please call 336-722-3441. After we have received your request, we will contact you to confirm delivery. If we have not contacted you within 24 hours, please call our office at 800-672-6604 or 336-714-5177. To avoid duplicate orders, please do not call to place an order if you have already submitted a request online. Thank you.

Name on Account *

First Name Last Name

Your name, if different

First Name Last Name

Account number, if known

Email address *

Physical Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Mailing address, if different

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

At least one phone number is required

Work Phone

Area Code Phone Number

Home Phone

Area Code Phone Number

Cell Phone

Area Code Phone Number

Request Type (choose one) *

Heating Oil Propane Kerosene

I am interested in the following programs

Keep Fill Customer Advantage Plan Easy Pay Automatic Draft

Percent in propane tank now (found on gauge under dome - propane only)

Amount requested - Next Day Delivery:100-Gal. Minimum or (Same Day Delivery: 150-Gal. minimum) *

Special Requests: anything we should be aware of?

Account changes or updates (e.g. new phone number, new address)

On the final step: You will be required to enter a digital signature which will be binding as your
actual signature. Your electronic signature below indicates your agreement with the following statements:

By typing my name in the following box I certify the above statements to be true and correct,
to the best of my knowledge, and that this information can be used for the purpose of processing
my request for home delivery.

Type your name here *

Enter the text shown in the image *

REQUEST COMMERCIAL FUELING OF FUEL OIL, KEROSENE, OR PROPANE