Refined Fuels Quote Form

How Soon Do You Need A Unit?

Customer Information

First Name:		Company Name:
Last Name:		Address:
Fax:		City:
E-mail:		State:
Phone:		Zip:

Lease/Finance Options

Would you like us to finance the order?

Yes (Please CLICK HERE to Complete a Credit Application)
No

Tank Information

I am hauling these products

(list all that apply)

Compartments:

1 2
3 4
5 6

Tank Size(Gallons):

2100 2300
2500 2800
4000 4500
(Please Note: Anything above a 2800 will require a tandem axle chassis and may be subject to a 12% F.E.T.)

Tank Model(if known):

10-ST 10-LS
20-ST 40-ST
50-LS 50-ST
80-LS 80-ST
90-LS 90-ST
A10-LS A10-ST
A30-LS A50-ST
A80-LS A80-ST
A90-LS A90-ST

Tank Material:

Steel
Stainless
Aluminum

At terminals, I am:

Top Loading
Bottom Loading. W/Vapor Recovery/Scully

Pumping System:

Single Pumping System
Dual Pumping System

Meter:

Neptune
LC

Hose Length (in feet):

Gas Side-
50 75
100 150
Diesel Side-
50 75
100 150

Nozzle:

Manual
Automatic

Additional Options:

Air Controls Hotshift
Dry Breaks with Jumper Hoses Manifold System

Chassis Information

Please complete the following information for the type of chassis you would prefer for either the vacuum tank or the portable restroom tank as listed above.

Brand:

Type of Transmission:

Horsepower:

Front Axle Rating:

Rear Axle Rating:

Dallas Sales Center
Danny McElroy
800-483-9971

lpg@aol.com
720 Ramsey - Batesville, Arkansas 72501
870-793-2374 | 800-548-7219 | FAX 870-793-8230