Application for Installing Oil Burner and Solid Fuel Central Heating  Equipment

User ID# (if applicable):  
 Subject:  

Property Owner Information
* First Name:                 
* Last Name     
(This e-mail address will receive electronic notifications, it does not have to belong to the property owner)
* E Mail:          
* Phone        
* Address1               
   Address2      
* City:                 * State  
* Zip             

Installation Information
Heating Unit is   Please Select New Used   
Oil Fired Hot Water  Tank     Please Select Yes No    
Central Heat:    Please Select Steam - Boiler Hot Water - Boiler Solid Fuel / Oil Combo Hot Air Furnace Solid Fuel Heating Unit  
Replacement Of Oil Burner Only  Please Select Yes No   
Make Of Heating Unit  
Model
Make Of Oil Burner       
Model
Grade Of Oil Burner     
Max. Firing Rate          

Draft Please Select Natural Forced   
Fuel Storage Tank in Gallons  
Tank Age Please Select New Used

Remarks On Installation 

Date Ready for Inspection:

Installer Information
Company Name (if any)   
License # Of Installer          
Installer Name  (First & Last) 
Installer's E-Mail
Installer's Phone
Address 1          
Address 2    
City         State            
Zip Code