SERVICE REQUEST FORM
For non-emergency service requests only

If you are out of oil or you have no heat or air conditioning,
please call 336-299-0531 (Greensboro), 336-887-1960(High Point)
or 336-784-6079 (Winston-Salem) for service.

Please fill out the form as completely as possible.
* Fields marked with an asterisk are required.

I am:

 A Current Customer
 Interested in Becoming a Customer

I have:

 A Service Agreement
 No Agreement

Account Number:

* Name:

Address:

City:

State:

Zip Code:

Service / Product:

 HVAC Service
 Fuel Oil Delivery
 Dyed Kero Delivery

Please provide at least one phone number, and an email address so we may contact you.
** Please make sure your contact information is accurate. **
We respect your privacy. We will not sell or distribute your contact information.

* Cell Phone or Work Phone:

* Home Phone:

* Email Address:

* Description of Problem or
Delivery Request:

Comments or Questions:

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*

  (Audio file of code)