RCM FUELS, LLC: Online Order Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your order! We will contact you with your delivery date and to process payment prior to your delivery.

Email *

Email Address: *

Account #: (If Known)

First & Last Name (on the account): *

Physical Delivery Address (including city, state, and zip): *

Select Your Product: *

Phone Number: *

Quantity you want delivered ($25 fee applies to any order under 100 gallons) : *

100 gallons (our minimum)

150 gallons

Fill

A specific $ amount (Please specify under delivery instructions $25 fee applies to any amount under 100g to cover our diesel expenses)

A gallon amount not listed in these options, please instruct under delivery instructions.

Payment Options: *

Pre-Pay via credit, debit, online payment.

Will leave a check for driver in a spot disclosed in the delivery instructions made out to RCM FUELS, LLC.

Leave cash in a place disclosed for driver in the delivery instructions.

Be home with payment. Please note we can not give specific delivery times and will not deliver fuel without payment. Thank you for understanding.

Use credit on account from NYS HEAP or paying on account

New Customers ONLY: Please list any additional phone numbers or names you wish to have associated with this account.

Please Note: We can usually deliver within 1 week. During busy season (November-February) call at least a week ahead to be safe. We offer Automatic Deliveries, check below if you would like more information emailed to you. We offer emergency deliveries for an additional fee of $125. If this is an emergency please call us and do not use this form. *

I agree and understand, please place my order

Please send me Automatic Delivery Information via email.

Required

Delivery Instructions for the driver: (Such as, check on fill pipe, white house with blue roof and detached garage, fill pipe on back left, etc. *

We will email you an order confirmation w/price and delivery date. Please make sure you don't have office.rcmfuels@gmail.com marked as spam and/or check your spam folder. If you do not have a response within 24 hours Monday-Friday please call.

Sounds good!

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms