Emergency Fuel Delivery Request

Emergency Fuel Delivery Request

Ran out of gas? We’ve got you. Submit your request below and we’ll get you taken care of as quickly as possible. A service fee is required to dispatch a driver.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Location of vehicle
Is it safe to access the vehicle?

Emergency Dispatch Fee

A $25 dispatch fee is required before we head your way. This secures your service and allows us to respond as quickly as we can.

$25.00 one-time payment

Enter coupon

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Vehicle Type
Vehicle Color
Vehicle Tag Number
This helps us identify your vehicle at the time of service.
Notes/Additional Information:
Emergency Fuel Delivery – Terms & Conditions

By submitting this request, you agree to the following:

Dispatch Fee
A dispatch/service fee is required prior to service. This fee secures your request and allows us to send a driver. The dispatch fee is non-refundable once the driver is en route.

Fuel Pricing
Fuel is billed separately at the daily market rate at the time of delivery. Total cost will depend on the number of gallons pumped.

Emergency Fuel Availability
For emergency fuel deliveries, regular unleaded fuel will typically be provided for gasoline vehicles unless otherwise confirmed prior to dispatch. Diesel fuel may be available for diesel vehicles based on availability. Premium fuel is not guaranteed during emergency service calls.

Minimum Service Expectation
This is a full-service fuel stop. We do not provide minimal “top-off” deliveries.

Payment Authorization
A valid payment method is required prior to dispatch. An authorization hold of up to $115 may be placed on the card provided before service is performed. This is not a final charge and allows us to verify funds availability prior to dispatch. Final fuel and service charges will be processed after fueling is completed. Any unused portion of the authorization will be released by your financial institution based on their processing times.

Vehicle Access & Safety
Customer must ensure the vehicle is safely accessible and able to be fueled. If the vehicle cannot be accessed safely upon arrival, the dispatch fee will not be refunded.

Location Accuracy
You are responsible for providing an accurate location. Delays or additional travel due to incorrect information may result in additional fees.

Wait Time
Driver will wait a reasonable amount of time upon arrival. If the customer is unreachable or unavailable, the service may be canceled and the dispatch fee will not be refunded.

Service Area
Service is limited to our active delivery area. If you are outside our service area, your request may be declined.

Right to Refuse Service
The Gas Man LLC reserves the right to refuse service in unsafe conditions or situations that put our team or equipment at risk.

Insurance Notice
Some insurance or roadside assistance providers may reimburse the service/dispatch fee. Fuel costs are not covered and remain the responsibility of the customer.
Required Checkbox
Tag ID
Should be Empty:

Emergency Fuel Delivery Request

Emergency Dispatch Fee*

Emergency Dispatch Fee