Oilheat Dealers Safety Product Order Form

OILHEAT DEALERS SAFETY PRODUCT ORDER FORM

FREE FOR POLICYHOLDERS ONLY!!!
Don't get caught short!
Make sure your delivery trucks are fully equipped!

Please use this form to order extra:

•	Oil Delivery Truck Accident Kits
•	Accident/Spill Hotline Stickers
•	Oil Delivery Driver Wallet Cards
•	Accident Scene Management Visor Cards

Accident Kit
Claims Hotline Sticker
Driver Wallet Card
Accident Scene Management Visor Card
NORA Training DVD
Safety Session 1 - ABCs of Fatigue
Safety Session 2 - Fighting The Effects of Fatigue
Please send me more of the following FREE items:
Accident Kits: qty.	Stickers: qty.
Visor Cards: qty.	Wallet Cards: qty.
Nora Training DVD (limit one per customer)
Safety Session 1: qty.	Safety Session 2: qty.

Your Name:
Policy Number:
Company:
Company Address:
P.O. Box:
City:
State:		Zip:
Tel:	( )
Fax:	( )
E-mail:

Please click on the "submit" button below to send this form electronically.
For any questions please call our Customer Service Department at
1-800-782-8902 ext. 3307