Proulx Oil and Propane

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Customer Service : Accounts : Propane Delivery Request

Important Notification

The form below is for Propane Delivery Requests. Orders received today will be fulfilled by 08/04/2010, provided that you receive confirmation from a Proulx customer service representative.

DO NOT USE THIS FORM FOR EMERGENCY DELIVERIES

Propane Delivery Requests will be confirmed by a Proulx Customer Service Representative.

Please complete the form below to request a delivery. Required fields are denoted with a red asterisk ( * ).

Propane Delivery Request
* Fuel Type :	Propane
* Delivery Type :	Fill Tank
* Approximate % of Tank Remaining :	%

Request the Pink Truck!

Proulx Oil & Propane is making donations to the American Breast Cancer Foundation as part of the "Fuel for Hope" campaign!

Yes I would like to participate by having Proulx Oil & Propane donate a portion of my delivery.

Customer Information

* First Name :

* Last Name :

* Delivery Address :

* City :

* State :

* Zip :

* Phone :

* E-Mail Address :

Proulx Account Information

* Existing Account? : Yes
Account Number: (If you have it)

Sign Up for a New Proulx Account

Would you like to receive email reminders and early notification of special promotions from Proulx?

Yes, please notify me
No, thanks

What is six+seven? Why are you asking me this?
(enter your answer as a number, as in six+one=7)

At Proulx Oil & Propane, we believe that safeguarding your online privacy is our responsibility. We have not, nor will we ever sell, rent or make available for use, your personal account information to any third party. Your e-mail address will be used only to e-mail reminders and early notifications of special promotions from Proulx if you choose to be notified.

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