We miss you.

Cleghorn has been committed to home comfort for over 90 years. And now, when you give us another chance, you will receive your first Bioheat heating oil delivery at just $.99 per gallon*!

Fill out this form today to take advantage of this low first fill price:

Applicant Name

SS Number

Phone*

E-mail*

Delivery Address

City

State

Zip

 Check if Address is The Same For Billing

Billing Address

City

State

Zip

Delivery Remarks

Special Instructions

Can Driver park in the driveway if fill pipe is less than 125 from the street?
 Yes No

How did you hear about us?

How is your fill pipe marked?

Fill Location:
(Click approx. location eg. BL = back left)


Complete If You Are a Tenant

Landlord's Name

Phone

Does Landlord have an account?
 Yes No

Account No.

Landlord's Address

City

State

Zip

Are you responsible for Service?
 Yes No

Delivery Information

Tank Size

No. of Occupants

Current Volume in Tank

Home Square Footage

Would you like automatic delivery?
 Yes No

Heating System Information

What kind of heating system?
 Steam Warm Air Forced Hot Water

Number of Zones

Is water heated by oil?
 Yes No

Hot water heater make

Do you have a free-standing Unit?
 Yes No

Do you have a tankless unit?
 Yes No

Is your hot water storage tank connected to your boiler?
 Yes No

Furnace/Boiler make

Is your house air-conditioned?
 Yes No

Date of last maintenance

Schedule cleaning or ultimate inspection?
 Yes No

When?

Are you interested in a service plan?
 Yes No

Credit Information

Applicant 1:

Employer

No. of Years

Phone

Previous address (if < 2 years)

Applicant 2 (if applying jointly):

Employer

No. of Years

Phone

Previous address (if < 2 years)

Applicant #1 Signature

Date

Applicant #2 Signature

Date

 I understand terms and conditions apply. Customer information is available by contacting the office.

 

 

 

 

 

 

 

*Offer expires September 30, 2016.