JOIN THE RIDGES OIL GROUP

Please complete the form and click submit. All entries must be received no later than May 1, 2011. Thank you.

                Name                     

                Address                  

                                            Stamford, CT   06905

                Phone number         

                Email address           @

                Estimated usage       300 400 500 600 700 800 900 1,000 1,100 1,200 1,300 1,400 1,500 1,600 1,700 1,800 1,900 2,000+

                Service contract      Yes No

                Billing preference  Prepaid Budget plan

                Current provider     

                Comments