DOMESTIC HEATING OIL ORDER FORM Status *   New Customer       Existing Customer  Account No Title * Select..Mr.Mrs.M/sDr.Rev. First Name: * Last Name: * Contact Details Valid Email Address * Telephone No: * Phone Type:   Home       Work       Mobile  Telephone No: Phone Type:   Home       Work       Mobile  Delivery Details Is Address the Invoice Address? *   Yes       No  House No or Name ONLY * Street Address * Street Address (Cont'd) Town * Postcode   * County * Select County...BedfordCambsEssexHertsKentNorfolkSuffolkSussex Invoice to Name & Address (If Different) Specific Delivery Instructions Product Required Current Supplier * Select Please....A D FUEL OILSBLACKWATER FUELSBROADLAND FUELSCASTLE LIQUID FUELSCPL PETROLEUMCPS PETROLEUMDIRECT HEATEMO (SHELL)FUELCARE (Q8, PACE)GOFF PETROLEUMHARDY CRASKELINTON FUEL OILSRIX PETROLEUMSOUTHERN COUNTIES FUELSUFFOLK FUELSTOTAL BUTLERWATSON PETROLEUMOTHER Product * Select Product....Heating Oil Quantity (Heating Oil Max 2300 Litres) * Existing Tank Levels Approx * Select Approx Existing Tank Level3/4 Full1/2 Full1/4 FullLess than 1/4 Tank Size (In Litres) Preferred Delivery *     dd/mm/yyyy Alternative Delivery *     dd/mm/yyyy Payment Method * Select Payment method...I will be in and pay on delivery.I will leave a cheque on the tank.I will post cheque to you within 3 days.I wish to pay by Credit Card.I wish to pay by Debit Card.Please bill my standing order account. Please note our standard terms of payment are payment on or before delivery. By pressing the "Order Heating Oil" Button you are agreeing to our terms and conditions. PRIVACY POLICY CPS Fuels is committed to protecting your privacy and security. We will only use the information we collect about you with your consent to tell you about our services & special offers. We will never wilfully disclose personal data about you to any third party without first receiving your permission or unless we are under a legal obligation to do so. * = Input is required

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