ABOUT AGRONOMY ENERGY RETAIL NEWS LOCATIONS CONTACT US CAREERS SDS EMPLOYEE PORTAL CUSTOMER PORTAL Order Form This order form is only for returning customers that have an active Hi-Line Co-op Charge Account. If you are a first-time customer with Hi-Line Co-op, please call us at 308-352-2800 to set up an account and place your energy order. Please fill this order form out as completely as possible in order to receive timely services. Please note that these orders will only be processed during regular business hours. You will receive a confirmation of this order by email or phone once the order has been processed by our staff. *Required Fields *Date Order: Calendar Today *Account Name: *Ordered By: *Cell Phone Number: Email Address: Tank Locations: Preferred Delivery Date: (We will get your order to you as quickly as possible, but we cannot ensure that the preferred date will be possible.): *Fuel: Fieldmaster Diesel Roadmaster Diesel Regular Unleaded E-10 *Fill Tank: YesNo If not, delivery amount: Other Info: Security code: Questions or Concerns about Ordering with us? Contact Amy Robertson or Dustin Dolezal at 308-352-2800. Hi-Line Co-op 203 S Perkins Ave PO Box 96 Elsie, NE 69134 308-352-2800 ABOUT AGRONOMY ENERGY RETAIL NEWS CONTACT US CAREERS LOCATIONS Privacy & Terms of Service | Site Map © 2019 Hi Line Co-op - All rights reserved