Name: Central Region Cooperative
Address: PO Box 429, Sleepy Eye, MN, 56085
Price range: $$

*Are you a first-time customer?:

Yes No

*First Name:

*Last Name:

Corporate name, if applicable:

*Phone Number:

Email:

If you would like an email confirmation of your order, please include your email.

*Delivery Address 1:

Address 2:

*City:

*State:

*Zip code:

*Product Type:

Tank 1

*Gallons Ordered:

Tank 1

Product Type:

Tank 2

Gallons Ordered:

Tank 2

Additional Instructions:

Security code:

REFINED FUELS ORDER