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Propane Online Order & Quote Form
ORDER PROPANE
GET A PROPANE QUOTE
Propane Order Form
Must have a chargeable account with Countryside to order propane online
*Required fields
Contact Info
*Name on Account:
Account Number:
Must be numeric
*Phone:
*Email:
Billing Address
*Billing Street:
*Billing City:
*Billing State:
Tank Location Address
*Same As Billing:
No
Yes
Tank Street:
Tank City:
Tank State:
Tank Zip:
*Please select a location near you:
Arcadia
Durand
Ellsworth
Fall Creek
Hammond
Milltown
Mondovi
New Richmond
Osseo
Pepin
Request a Refill on Any of the Following
*Request Type:
Propane
Fuel Oil for Home Heating
Fuel
Tank Percentage:
Estimate of Gallons Requested:
Unknown - Please Fill Tank
Less than 200 Gallons
200 Gallons
250 Gallons
300 Gallons
More than 300 Gallons
Propane Comments:
Fuel Oil Inches in Tank:
Estimate of Fuel Oil Gallons Requested:
Unknown - Please Fill Tank
Less than 200 Gallons
200 Gallons
250 Gallons
300 Gallons
More than 300 Gallons
Fuel Oil Comments:
Fuel Inches in Tank:
Type of Fuel:
Gasoline - 87 with Ethanol
Gasoline - 87 without Ethanol
Gasoline - 91 Premium
Off-Road Diesel
On-Road Diesel
Gallons of Fuel Requested:
Unknown - Please Fill Tank
Less than 200 Gallons
200 Gallons
250 Gallons
300 Gallons
More than 300 Gallons
Fuel Comments:
Security code:
Countryside Cooperative
PO Box 250
514 East Main Street
Durand, WI 54736
Phone:
715-672-8947
Toll-free:
800-236-7585
Fax:
715-672-5131
Propane Quote Request
*Required fields
*Name:
*Phone:
*Email:
*Street Address:
*City:
*State:
AL Alabama
AK Alaska
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FL Florida
GA Georgia
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
OH Ohio
OK Oklahoma
OR Oregon
PA Pennsylvania
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
*Zip:
*Are you a current customer?:
No
Yes
Type of Account:
Residential
Farm
Commercial
*Please select a location near you:
Arcadia
Durand
Ellsworth
Fall Creek
Hammond
Kings Valley Osseo
Milltown
Mondovi
New Richmond
Pepin
Waumandee
*Product(s) for which you need a quote:
Fuel Market Price
Fuel Oil Market Price
Other/Commercial Requests
TrueComfort+ Price
New Customer Installation Price
Pre-Buy Price
Propane Market Price
Fixed Price
If Other/Commercial, please list more details:
Security code:
Countryside Cooperative
PO Box 250
514 East Main Street
Durand, WI 54736
Phone:
715-672-8947
Toll-free:
800-236-7585
Fax:
715-672-5131