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Place An Order
Order Entered By
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Fuel Lube or Equipment?
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Select One
Fuel
Lube
Equipment
Fuel and Lube
Diesel Exhaust Fluid
Account #
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Customer Name
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Contact Phone
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Purchase Order
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Will the order be WILL CALL or would you like for us to DELIVER?
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If delivery, please state preferable date and time?
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Address
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City
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Select One
El Paso
Chaparral, NM
Berino, NM
Santa Teresa, NM
Canutillo
Vinton
Anthony
Anthony, NM
La Union, NM
Socorro
Horizon City
San Elizario
Clint
San Miguel, NM
Vado, NM
Mesquite, NM
Fabens
Mesilla Park, NM
Tornillo
Special Notes for C&R Distributing Warehouse:
Fuel Order Details
Package Options
DYED DIESEL
UNDYED DIESEL
UNLEADED GASOLINE
PREMIUM GASOLINE
SUPREME GASOLINE
Total Gallons Requested
Package Options #2
No Second Order
DYED DIESEL
UNDYED DIESEL
UNLEADED GASOLINE
PREMIUM GASOLINE
SUPREME GASOLINE
Total Gallons Requested #2
Lube Order Details
Product Name
Package Options
BULK GALLONS
PAIL
DRUM
CASE PACKAGE
Quantity of Selected Package
Equipment Order Details
Equipment Part Number
Equipment Details
Please add any additional orders here
