Please provide the following information for yourself, the nominator.

First Name *

Last Name *

Phone *

Email *

Please provide the following information regarding the person or family you are nominating.

First Name *

Last Name *

Street Address *

City *

Zip *

State

Email *

Phone *

HOW WOULD YOU BEST CLASSIFY THE NOMINEE? *

SHARE YOUR STORY *

IS THEIR OIL TANK ABOVE OR BELOW GROUND? *

IS THEIR OIL TANK INSIDE OR OUTSIDE? *

DOES NOMINEE/FAMILY OWN THIS HOME? *

DOES NOMINEE CURRENTLY RECEIVE HEATING OIL THROUGH AUTOMATIC DELIVERY OR COD (CASH ON DELIVERY)?

HOW DID YOU HEAR ABOUT US?

HOW DID YOU HEAR ABOUT US? (Other Details)

Please read and review the Program Rules and the Terms and Conditions before continuing.

Custom consent *

* I have received permission to share the above information regarding the nominee.

Consent 2 *

* I have reviewed and agree to nominator terms and conditions. I agree to being contacted by Tragar Home Services.

Program Rules *

* I have reviewed and agree to the program rules.