Wufoo
Account Payment - Jernigan Oil Co., Inc.
Pay towards your account with Jernigan Oil Company with this online form using your credit card via PayPal.
Any non-residential payments made online will be assessed the PayPal transaction fee associated with each payment. PayPal charges a 2.9% exchange fee plus .30 for each transaction processed. Please be mindful of this prior to submitting your payment. Thank you.
Name
*
First
Last
Address
*
City
*
State
*
Zip Code
*
Phone Number
*
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####
Email Address
Account Information
Account Number
*
Type of Fuel
*
LP / Propane
Gas / Diesel
Duck Thru Credit Card
Please select one.
Ticket Number
Amount being paid toward account
*
$
Dollars
.
Cents
Notes or Comments
Do Not Fill This Out