First Name *

Last Name *

Your Email (this will be our main form of communication) *

Mailing Address

Phone Number *

Delivery Address*

Fuel Type *
PropaneFuel OilKerosene
Please note: Fuel oil customers in the Brattleboro area will use biofuel. This generally runs about $.10 more than traditional fuel oil.

Who Is Your Current Supplier? *

How Many Gallons Do You Use Per Year? *

Do you have more than one tank at your primary location that needs to be filled? If your tanks are hooked together it is considered one tank. If they are at separate locations on your property, they are each considered a separate fill location.
YesNo

Delivery Address #2 (Leave blank if you don't have a 2nd location)

Fuel Type (Leave blank if you don't have a 2nd location)
PropaneFuel OilKerosene

Please note: Fuel oil customers in the Brattleboro area will use biofuel. This generally runs about $.10 more than traditional fuel oil.

How did you hear about us?
Received EmailReceived MailingFrom Friend / FamilyFrom Porch ForumChester TelegraphFacebookBrattleboro Coop Newsletter

Name of your referral (if you had one).

Comments

Terms and conditions: Member must pay membership fee in full to be eligible for NSG pricing. Member fee is non-refundable. It is the member's responsibility to deal directly with the fuel company for delivery, for service and billing and to be aware of the Dealers policies. We do not handle fuel payments or billing disputes. The fuel supplier establishes Member’s credit standing and payment terms based on member’s credit history. Member must keep their account in good standing with his/her fuel supplier or the fuel supplier has the right to discontinue NSG pricing. NSG reserves the right to add or discontinue service with a supplier at any time. The rate structure is subject to change in the course of the season.

Waiver of liability: I understand the only responsibility of NSG is to negotiate pricing. NSG has no other responsibility for and shall not be liable for anything else, including fuel delivery, fuel spills, member’s non-payment, etc. I agree to indemnify and hold NSG harmless for any and all liabilities, injuries, unforeseen events and costs of any kind. I understand that this does not prevent me from seeking damages from my fuel dealer or my insurance company if necessary, due to accident or unusual event.

I have read the terms and conditions