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Please select one of the following forms:

  • Bulk Fuel Delivery
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Bulk Fuel Delivery - Start
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 BULK FUEL DELIVERY ORDER FORM
Your retail is not signed up for bulk fuel delivery service. For further questions please contact your retail.  
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Billing Information
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Fuel Order Information
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* Do you have a delivery address?
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* Fuel Information
There are no submissions.
#   * Type of Fuel Product * Size of Tank * Quantity Required * Units
The quantity required cannot be greater than the tank size.
Please ensure you have filled out the tank size and quantity required.
Please select a product type from the list.
Please select the units from the list.
This value is required.
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* Do you require any oil or lubricant products?
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         Please fix validation errors listed above.
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●SUBMIT
●CLEAR
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Thank you for submitting your bulk fuel order through the Co-op Online Bulk Delivery Form. We would like to inform you that your order has been received by your local Retail Co-operative and is being processed. You will be contacted soon to confirm your order.

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Retail Co-op : 
Your Co-op Number : 
First Name :
Last Name :
Phone Number :
 Email ID : 
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Delivery Address :
Delivery Date: 4/26/2025
* Fuel information Press the green button to add fuel requirement
Type of Fuel
Size of Tank
Quantity Required
Units
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 Do you Require any oils/lubricants : 
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* Email Info for Given Retail
Email Type
Email Value
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There are no submissions.
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  3. ●Remove
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Outputs when testing:
  • Sends email to the "
 
Items Requiring Modification: 
  • Make sure CPA Database email is pointing to an email from webteam. (Select * from Functions where (Function_Type_ID=6 OR Function_Type_ID=7 OR Function_Type_ID=8) AND Deleted=0 order by Reference_ID )
 
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