New Jersey Citizen Action Oil Group
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Become A Member - Save !!
Become a Member Step 1
Member Info
First Name
Last Name
Business Name
Mailing Address
City
Zip
County
-Select-
Atlantic
Bergen
Burlington
Camden
Cape May
Cumberland
Essex
Gloucester
Hudson
Hunterdon
Mercer
Middlesex
Monmouth
Morris
Ocean
Passaic
Salem
Somerset
Sussex
Union
Warren
Phone
Cell
Date Of Birth
Email Address
How Did You Hear About Us?
-Select-
A Current Oil Group Member
Friend
Yellow Pages
A Search Engine Such As Google, Yahoo or Bing
My Union or other NJCA Affiliate
New Jersey Citizen Action Employee or Loan Counselor
TV, newspaper, magazine, or radio
Blog
Email
Legislator
My Oil Company
Mail
Professional Conference
Other Oil Group
Economic Assistance Agency
Real Estate Agent
Poster
Any Other Website
Church
NP AD
Train
Postcard
Other
If current group member, please give their full name and address so that they can receive a free year of membership!
If you are a landlord and will be renting the property to a tenant who will be ordering and paying for the oil deliveries, we must have the tenant's name on file. Please provide the tenant’s name here:
Delivery Info
Same as Member
Delivery Address
City
Zip
County
-Select-
Atlantic
Bergen
Burlington
Camden
Cape May
Cumberland
Essex
Gloucester
Hudson
Hunterdon
Mercer
Middlesex
Monmouth
Morris
Ocean
Passaic
Salem
Somerset
Sussex
Union
Warren
Property is
Owned
Rented
Landlord name
Current Oil Co.
We will not attempt to contact your current supplier in any way. We need to know if you are currently using one of our suppliers. If this is the case, we will place you with them for your convenience unless otherwise requested by you.
Tank Size
Tank Location
Underground
Above Ground
Inside
Fill Pipe Location
Annual Fuel Consuption
Last Delivery Date
Oil Hot Water Heater
Yes
No
Interested in a Service Plan?
Yes
No
Interested in Tank Insurance?
Yes
No
Notes
Help Us Match Your Needs to Our Suppliers
Delivery Type
Auto Fill
Will Call
Automatic Fill: The dealer monitors your usage and automatically fills your tank when you are running low. Will Call: You call the dealer for a delivery when you want oil.
Payment Options
20 Day
Budget
COD
20 Day Billing: The dealer makes a delivery and then you have 20 or 30 days to make a payment in full. Budget Billing: The dealer spreads your payments out evenly over the course of a year. COD: Cash on delivery.
Fuel Type
Bio-Fuel
Standard Fuel Oil
If you live in any of the following counties, you may have the option of using bio-fuel: Bergen, Essex, Hudson, Middlesex, Morris, Passaic, Somerset, Sussex, Union.
Do You Need Oil Immediately?
Yes
No
Select Your Membership
You must select one or more.
$30.00 individual household
$20.00 senior citizens (60+)
$35.00 commercial organization
$6.00 each additional delivery address
$0.00 LIHEAP Recipient (Proof Required)
Membership Payment Method
Credit Card
Check
Money Order
Postcard
If paying by Check or Money Order, please make payable to NJCAOG and mail it along with a printout of the completed application form (THIS PAGE) to: NJCAOG, 1040 North Kings Highway, Suite 308, Cherry Hill, NJ 08034.