First Time Delivery Form



412 Van Horn (907) 452-4477 P (907) 374-2888 F help@fairbanksfuel.com	If you have not had a delivery from us, and would like to request one, please fill out this form. Someone from our office will contact you no later than the next business day. Answers are Required for Questions in Red


First and Last Names
Delivery Address
Daytime Phone Number
Email Address
Number of Gallons Requesting (Minimum Delivery is 100 Gallons)	100-200 201-300 301-400 401-500 more than 500
Are we topping off your tank?	yes no

Type of Fuel	# 1 (for above-ground tanks and all Toyo & Monitor stoves) #2 (for buried tanks with buried fuel lines) -
If you have multiple tanks at this location, please be specific about which tank..
Special Instructions (These are examples): Do we call you in advance? Do you need to unlock gate or tie your dog? Are you leaving the check in a special place for the driver?