Refill Request Form

Spalding Gas Refill Order Form

Please fill in the requested information below to request a gas refill.

Our current pricing as of 07/02/2008

50 to 99 Gallons cost $3.30 per gallon, plus tax

100 Gallons cost $2.80 per gallon, plus tax

150+ Gallons cost $2.70 per gallon, plus tax

300+ Gallons cost $2.65 per gallon, plus tax

Senior Citizen Discount ( 60+ yrs. old ) is $.03 per gallon

Budget Customers on Auto Fill Discount is $.02 per gallon

Direct Payment Customers Discount is $.02 per gallon

Please note: Pricing is subject to change.  Please contact us with any questions.

This delivery will be made the next business day after you submit this form!

Please do not enter any credit card data in the "Comments" section.

Customer Name:*
Daytime Phone Number:*
Street Address:*
City*
Account Number (if known):
Quantity Requested for Delivery:*
Payment Method:*
Comments
Submit
*Required


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