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Fuels Tank Set Questionnaire

Customer Information

Customer Name

County

Township

Customer Type

Residence Type

Commercial

Will someone be home?

Are there any pets/animals that need to be secured?

Tank #1 Information

Explain "no set policy" Competed

Tank Size

Product

Tank Location

Fill Location

Directions

Tank #2 Information

Tank Size

Product

Tank Location

Fill Location

Directions

Tank #3 Information

Tank Size

Product

Tank Location

Fill Location

Directions

Are any of these tanks plumbed together?

Please check what appliances will be fueled from the tanks Furnace Water Heater Boiler Space Heater

Please select other sources for heat (click all that apply) Wood Pellets Corn Electric Geo Other

Commercial Fuel Account - The following questions relate to Commercial Fuels customers. Skip this section and go to the bottom of the form to submit, if this does not apply to the customer.

Are purchases tax exempt?

If Tax Exempt is "Yes" - Federal Tax ID#

Job Site Contact Name

Business Phone

Cell Phone

Project Start Date

Estimated Length of Project

Estimated Annual Gallons

Estimated Fuel Delivery Quantities

Estimated Delivery Frequency

Delivery Type (Keep Full, Will Call, Etc)

Wet Fueling Required?

If Wet Fueling is "Yes" - How Many Pieces of Equipment?

The following section relates to equipment loaned or leased by Crystal Flash Energy to the customer

Does the customer require CFE loaned equipment?

Pump Type

Length of Pump Hose

Are Double Walled Tanks Required?

Is Secondary Containment Required?

Lease Fee Applicable?

If Lease Fee is "Yes" - Lease Amount

Lease Fee Re-occurrence

Discuss distance requirements for tank placement Completed

Confirm that electric is available at job site Completed

Additional Comments

Skip

CSR Email to Receive Report *