Application-Residential

5658 Kessler Rd Belgrade, MT 59714 (406) 388-8227 Fax (406) 388-8288

Residential APPLICATION

First Name
Last Name

Physical Address:

Address Line 1

Address Line 2

City
State
Zip

Mailing:
Same as Physical Address

Address Line 1

Address Line 2

City
State
Zip

Home Phone
Cell Phone
Email Address
Tax ID

OR
Social Security Number




Upon Approval of Applicant (s) credit, Applicant (s) hereby Accept to the Following Terms and Conditions:

PAYMENT TERMS, NET 10 DAYS – DUE AND PAYABLE IN FULL 10 DAYS FROM DATE OF DELIVERY AND /OR SERVICE

Failure to pay the full account balance within 30 days from date of delivery and/ or service may result in a default and the assessment of LATE CHARGE and /or RE-BILLING CHARGE. The customer agrees to pay all invoices 10 days from the date of delivery or service work. In addition to tank rental and propane charges, we may charge our Customers various charges as applicable, including, without limitation, A over Time Charge, “out of gas” service charge, tank disconnect and or Tank pickup. These charges may also vary in amount depending upon the volume of propane purchased, Customer classification, Customer location and ownership of equipment. You may obtain a current schedule of our charges by contacting our office. You agree to pay the rates and other charges in effect on the date that propane is delivered or services are rendered. Taxes: The customer agrees to pay all personal property taxes and other taxes, assessments or similar charges that may be levied on any tanks or equipment while in the possession of the customer. Use of Tank: To promote safety and to comply with regulatory codes, the customer will not allow anyone other than the company to supply propane into any tank owned by the company which is leased or loaned to the customer. These terms will be subject to the individual laws of the state from which they were entered into and those laws will supersede any provisions of these terms that may run counter to those statutes.

The Company shall have no obligation to supply, or continue to supply, any propane, tanks, equipment or services to any customer failing to make timely payments in accordance with the Payment Terms or is otherwise in default of any obligation to the Company.


Initials


By initialing the box above and pressing the Agree and Apply button below, you are authorizing the credit grantor to obtain credit reports for the purpose of evaluation of credit performance in connection with this application. To assure an adequate supply of L. P. Gas, I / We will allow and be responsible for deliveries of L. P. Gas without signature at the time of delivery. I / We acknowledge that service may be disconnected if payment is not made in accordance with our terms. This authorization and request for delivery remains in effect until revoked by either party in writing.