Please enable JavaScript in your browser to complete this form.ULSD Diesel Contract1-Address:Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState2-From nearby major road or intersection , how would a driver approach your house?3-Please give us a brief description of your Yard or Site4 Where is the tank & Trucks Located?Tank Size *Select your PreferenceULSD-CLRULSD-REDTank Location & Access CodeYard & Site ManagerEmergency NumberEmergency NumberPer Gallon $4.38Pricing Confirmation *Please write the price you see per GallonEmail *Please check accordingly :For Will Call Only check here (initials)For Schedule-auto check here (initials) Customer is responsible for notifying Supreme Oil & Service at least 2 business days before delivery. Customer agrees that all deliveries will be paid by credit card unless SUPREME OIL & SERVICE agrees to payment by invoice after a credit check. If customer consumes more than 3,000 gallons per week, payment must be made by electronic funds transfer (EFT). Customer agrees to pay all invoices in full within 10 days of being billed. Customer agrees to park all vehicles in one location near one another if delivery is made on-site. Customer agrees to pay a late fee when payment is delayed. Customer agrees to pay a late fee when payment is delayed. Customer agrees if the delivery is above the number of gallons requested, payments of the difference will be made monthly. Additional fees may apply on complex deliveries, after hours deliveries or deliveries below stated minimums. Customer agrees to provide a delivery schedule and description on delivery protocols. Signed: *Clear SignaturePrint Name *Date *For all billing questions, the office is available M-F during work hours 8am-5pm. After hours are for EMERGENCY only. Due to high volume of calls and limited staff, please leave a voice mail, e-mail or text and we will reply in a timely manner. If you need immediate access to your account, please log-in to your account via the Supreme website to view the delivery history, balance due or to make payment.Submit Form