Propane Refill Form

If you have checked your tank and need a refill, please complete the form below to request to have a delivery made to your home, farm or business. Refill service is available only to current Country Visions customers in good standing. Please allow up to 5 business days for delivery as our driver routes are planned in advance.

*Name on Account:

*Account Number:

Phone:

Email:

*Billing Address:

Billing City:

Billing State:

*Delivery Address Same as Billing?:

Yes No

*Please refill:

Propane Fuel Oil Fuel

Percent (%) remaining in tank:

Security Code:

Contact Us

Brillion, WI: (920)754-2240
Menominee, MI: (906)863-2646
New London, WI: (920)982-1111
Oconto Falls, WI: (866)455-7200