NEW CUSTOMER CREDIT APPLICATION AND ACCOUNT SET-UP FORM

The information supplied is accurate as of the date shown;
An investigation of all statements or credit data herein and release of such information to DCC Propane, LLC or any of its subsidiaries, from any and all sources is authorized;
A release is granted to all parties from all liability for any damage that may result from furnishing information to you;
If applying for credfit, to recognize that your individual credit history may be a factor in the evaluation of this application.
If applying for credfit, 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
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 where applicalble, 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.

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; and, 5. 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.