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(570) 258-8008

ORDER FORM

Name

Phone Number

Delivery Address

Requested delivery amount

Minimum delivery is 50 gallons.

Customer status *

New customer

Existing customer

Payment *

Credit card: Initial setup is done over the phone to protect your information you will receive a call. first time only, or to setup a new card.

Credit card on file

COD - Cash/check

Tank Orientation *

Basement

Outside/Above Ground

Buried Underground

Diesel Fuel/Heating Oil Anti-Gel Additive

$16.96 - Treats up to 275 gallons

Recommended for Outside tanks

• Stops Gelling at Sub-Zero temp.

• Disperses Water/Inhibits Corrosion

• Prevents Filter Icing/Cleans System

• Cleans & Protects Fuel System

Select the approximate location of full pipe relative to the FRONT of the house. *

Front

Front Right

Front Left

Right Site

Left Side

Back Right

Back Left

Back

Other

FRONT

BACK

RIGHT SIDE

LEFT SIDE

FRONT RIGHT

FRONT LEFT

BACK LEFT

BACK RIGHT

Additional delivery info/customer requests

Delivery confirmation

I would like to receive a call to confirm my delivery.

Emergency Deliveries After-Hours Please Call To Confirm Order Is Received

* All new customers and customers without a credit card on file will receive a confirmation call

(570) 258-8008 / 1 (855) 764-0635

Thanks for placing your order! Victory Fuel will contact you to process your order.

CALL US

Toll Free

570-258-8008

Open 24/7 for emergency deliveries.

Toll Free: 1 (855) 764-0635

Fax: (267) 371-7045

P.O. Box 13 Lehighton, PA 18235 📬

EMAIL US

info@myvictoryfuel.com

HOURS OF OPERATION

Summer Office Hours

(May 31 - August 31)

8am-5pm, Monday-Friday

Winter Office Hours

(September 1 - May 30)

6am-5pm, Monday-Saturday

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