John's Oil Co
5 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
 
master-card
 
debit-cards
 
discover
 
american-express2
 
HOW DO YOU HEAT YOUR HOT WATER: (CHECK ONE)
 
LOCATION OF FILL PIPE (CIRCLE ONE)
 
ARE YOU INTERESTED IN A SERVICE CONTRACT?
 
(NEED TO INSPECT UNIT)