Customer Portal Login About Existing Customers New Customers Residential Commercial Fleet Fuel Order Contact Home Order Form – Commercial Order Request Order Form – Commercial Order Request Online Order Form for Existing Commercial Customers Easy-to-use order form. Existing customers, please fill out the order form below for off-road diesel, on-road diesel, propane, gasoline, DEF, propane tanks, lubricants, and more. New commercial customers, please visit the application page. Payment information is not required to fill out the form. Payment will be arranged with confirmation of delivery. Name* Email* Phone* Preferred Method of Contact* Please Select Phone Email Billing Address* Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Delivery Address Same as Billing Address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code I am interested in ordering the following product(s) On Road Diesel Off Road Diesel Gasoline Propane Fuel Tank Request Diesel Exhaust Fluid Lubricants/Grease Service for tank/pump Miscellaneous Request Order Details Please check this box if you would like to be added to the Couch Oil Company e-Newsletter list. Subscribe Please check this box if you would like to be added to the Couch Oil Company e-Newsletter list. By submitting this form, you are consenting to our privacy policy. Our Hours: Monday - Friday: 7am - 4pm We proudly carry: Copyright © 2021 Couch Oil Company. All rights reserved. | Sitemap | Raleigh Web Design + SEO by TheeDigital Couch Oil Company 2907 Hillsborough Road, Durham, NC 27705 - (919) 286 - 5408