Customer Account Survey

Account Number

Do you have more than one Valley Energy Account?(Required)

Yes

No

Name(Required)

First Last

Email(Required)

Primary Email Contact For Important Information Regarding Your Account

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone(Required)

Can we text this phone number?(Required)

We promise to use this feature as a tool to remind you of any upcoming deliveries, service appointments, or important account notifications. We will not send you spam or marketing messages.

Do you wish to add a secondary contact to the account?(Required)

Yes

No

Secondary Contact Name

First Last

Secondary Email

Secondary Phone Number

Can we text this phone number?

We promise to use this feature as a tool to remind you of any upcoming deliveries, service appointments, or important account notifications. We will not send you spam or marketing messages.

How likely are you to recommend Valley Energy?

Very Likely

Somewhat Likely

Not Sure

Not Likely

Definitely Not Likely

Any additional questions, comments, or feedback?(Required)

Signature(Required)

CAPTCHA

Propane Customer

Heating Oil Customer

Phone Numbers

Email Address

Address