Order Fuel

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1. First name *
2. Last name *
3. Company
4. Address *
5. Apt./Suite #
6. City *
7. State * Please select your state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington State West Virginia Wisconsin Wyoming
8. ZIP code *
9. E-mail *
10. Phone (with area code) *
11. Preferred method of contact

    Email Phone
12. Do you have an account with Farmers Union Trading? *

    Yes No
    1. Account number *
13. Payment method *

    Cash on delivery Check Card (will contact for details)
14. Select fuel type *

    Propane Bulk fuel
    1. Tank location and description *
    2. Tank size (gallons) * Please select your tank size 250 500 1,000
    1. Select bulk fuel type(s) *

       No lead Premium Roadmaster Fieldmaster
    2. No lead gallons *
    3. Premium gallons *
    4. Roadmaster gallons *
    5. Fieldmaster gallons *
15. Delivery/special instructions

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