Home
Our Services
New Customers
Careers
Gallery
Contact

16440 Industrial Drive, PO Box 25, Milford, VA 22514

(804) 633-6800

E.M. Gray & Son

16440 Industrial Drive, PO Box 25, Milford, VA 22514

(804) 633-6800

E.M. Gray & Son

Home
Our Services
New Customers
Careers
Gallery
Contact

New Customers

New Customers

New Account Application Form!

Account Application Form

Type of account requested

Date

First Name*

Last Name*

Street

Number

Length of time there

Own or Rent

Employer

Employer Address

Employer Number

Nearest relative (not living with you)

Address

Phone Number

Co-Applicant Name

Co-Applicant Phone Number

Co-Applicant Employer

Co-Applicant Employer Address

Co-Applicant Employer Phone Number

Product Information

Previous Supplier

Product Type

Tank Size

Above Ground or Underground Tank

Automatic Delivery or Will Call

Thank you for contacting us.
We will get back to you as soon as possible.

Oops, there was an error sending your message.
Please try again later.

E.M. Gray & Son

(804) 633-6800 | (800) 590-GRAY

Mon - Fri: 7:30 am - 5:00 pm

Follow Us

Payment Options

Our Services

Propane
Diesel, Fuel, & Gas
Commercial Fuel

Propane Tanks
Tank Removals

© 2025

E.M. Gray & Son

Share by: