KREISERFUELS.COM
Central Pennsylvania's Premier Fuel Provider
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New Customer Sign-Up
New Customer Sign-Up
Please use this form to signup for a New Account. You may also contact our offices at 717-865-2105 or 800-782-3835 or by fax at 717-865-4708.
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Email Address:
Last Name:
First Name:
Middle Initial:
Address
City:
State:
Zipcode:
Phone:
Comments:
Delivery Address (If different from listed):
This is a (Please Check one below):
RENTAL
RESIDENCE
BUSINESS
Is the street # on your house or mailbox?
YES
NO
Where is your Fuel Tank located?
Where is the fill located?
How big is the tank?
Do you heat your water with oil?
YES
NO
What fuel do you use?
Oil
Kerosene
Winter Mix
Are you interested in Automatic Delivery?
YES
NO
Would you like a credit application sent in order to open for a 30 day revolving credit account?
YES
NO
122 Race Horse Drive | Jonestown, Pennsylvania 17038 | (P) 717-865-2105 | (F) 717-865-4708