15 Avon St, Lynn, Massachusetts 01905 / 781-592-9505 / www.johnsoil.com
AUTOMATIC DELIVERY AUTHORIZATION FORM
I, _____________________________________. DO HEREBY GIVE JOHN’S OIL COMPANY PERMISSION TO CHARGE MY DEBIT CARD, MASTERCARD, DISCOVER, VISA OR AMERICAN EXPRESS ACCOUNT LISTED BELOW FOR EACH DELIVERY OF OIL MADE TO MY PROPERTY. I UNDERSTAND THAT EACH DELIVERY WILL BE AT THE CASH PRICE FOR THAT DAY AND INCLUDES AN AUTOMATIC DISCOUNT. ALL SERVICE WILL ALSO BE CHARGE AUTOMATICALLY TO MY CARD ON FILE.
CIRCLE ONE
 
VISA CARD
 
MASTERCARD
 
BANK DEBIT VISA CARD
 
BANK DEBIT MASTERCARD
 
DISCOVER
 
AMEX
 
 
 
HOW DO YOU HEAT YOUR HOT WATER: (CHECK ONE)
 
 
 
 
 
 
 
 
 
 
 
LOCATION OF FILL PIPE (CIRCLE ONE)
 
LEFT SIDE
 
GAS
 
ELECTRIC
 
 
 
 
 
HOW MUCH OIL LEFT IN OIL TANK? ____________
ARE YOU THE OWNER? _______________
ARE YOU INTERESTED IN A SERVICE CONTRACT? YES_______ NO_________ (NEED TO INSPECT UNIT)

 
 
 
 
(example: left front, right front, left side, right side, left rear, right rear)
 
Type Fill to Fill Tank
 
Please select payment method
 
 
 
 
 
 
 
 
 
 
Credit Card Information
Fill out credit card info only if you want to use a new card or we dont have your card on file
 
 
 
Card Type
 
 
 
 
 
 
* 1 Printed name(s) on check must match the name(s) on the John's Oil account.
2 The driver license number of the person whose name is on the check must be provided at the time the order for oil/service is made.

** Only MasterCard and Visa logo credit/debit cards are accepted at this time.
*** The first delivery to any address (that we have never delivered to or have not delivered to in the last 6 months) the driver is required to physically check the tank and pipes prior to delivering any
oil.
Delivery Methods:
 
 
 
 
your address based on a computer program which attempts to optimize your delivery at approximately 165 gal (+/- 20 gal). See Automatic Delivery Requirements for more details regarding this delivery method.