NEW CUSTOMER CREDIT APPLICATION AND ACCOUNT SET-UP FORM

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APPLICANT INFORMATION

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Previous Address (if less than 1 year at current residence)

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EMPLOYMENT INFORMATION

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FINANCIAL REFERENCES

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IMPORTANT NOTICE TO CUSTOMER *

By signing below, you agree to the following

Important Notice to Customer – by signing below you agree to the following:
1. The information supplied is accurate as of the date shown;
2. An investigation of all statements or other credit data herein and release of such information to DCC Propane, LLC or any of its subsidiaries, from any and all
sources is authorized;
3. A release is granted to all parties from all liability for any damage that may result from furnishing information to you;
4. To recognize that your individual credit history may be a factor in the evaluation of this credit application;
5. You consent to and authorize the use of any external credit reporting information utilized by DCC Propane, LLC or any of its subsidiaries, from time to time as may be needed; and
6. Authorization is granted to disconnect my gas line from my current supplier’s tank; move current supplier’s tank and replace with DCC Propane tank and to transfer propane from current supplier’s tank to DCC Propane’s tank. I HEREBY GRANT A SECURITY INTEREST IN THE TANK(S) DESCRIBED ABOVE TO DCC Propane, LLC TO SECURE ANY AND ALL AMOUNTS WHICH MAY BECOME DUE ON MY ACCOUNT. I AGREE TO BE RESPONSIBLE FOR ANY BALANCE WHICH IS DUE OR MAY BECOME DUE ON THIS ACCOUNT. Unless otherwise required by law, all sales are final. No cash refund will be provided and any credits on account will be applied to the next propane delivery or can be transferred to another account. I further agree to have my account set up on Auto Route which means deliveries will be made without the need for me placing an order.

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Tank Lease We can provide on-site storage equipment starting as small as 125-gallons right up to configurations supplying thousands of gallons of on-site fuel storage.

Easy Online Payments Sign up for online account access. You can view your invoice, pay online and review your service history.

Tank Switch Out Leasing a tank from another provider? No Problem. We switch out your old tank for a new one, move any propane you may have already paid for and call your previous provider to have them pick up the old tank!

Remote Tank Monitoring For added convenience, we offer wireless tank monitoring systems. Your tank “phones home” so we always know when you need propane and schedule your deliveries accordingly.