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1. First name *
2. Last name *
3. Company
4. Address
5. City
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7. ZIP code
8. E-mail *
9. Phone (with area code) *
   1. Note: By providing your phone number to Farmers Union Oil Co., you agree and acknowledge that Farmers Union Oil Co. may send text messages to your wireless phone number for any purpose. Message and data rates may apply. Message frequency will vary, and you will be able to opt-out by replying “STOP”. Assistance can be found by texting “HELP”. Please review our privacy policy for more information on your data will be handled.
10. Preferred method of contact

    Email Phone
11. Your message *