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NEW COMMERCIAL ACCOUNT APPLICATION

PREFER TO FILL THIS APPLICATION OUT BY HAND?
CLICK HERE FOR A PDF TO PRINT/SEND VIA FAX OR MAIL

INSTRUCTIONS FOR ONLINE APPLICATION BELOW:
1. Please fill out this application in full.
2. Read the CREDIT TERMS & CONDITIONS then click the agree check box.
3. Read the PERSONAL GUARANTEE then click the agree check box.
This will then turn on the SUBMIT button.
4. Click the SUBMIT button on the bottom to submit the final form.
NOTE: You will be sent to a Thank You page when your application is successfully submitted.

NOTE: THIS FORM REQUIRES YOU CLICK BOTH CHECK BOXES.
IT WILL NOT BE SUBMITTED WITHOUT BOTH CHECK BOXES.

*Required Field

 
Customer Applicant

Social Security Number Strictly Confidential
For Credit Verification and Internal Use Only.

Mailing Address

Is your delivery address the same
as your mailing address?

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Customer Phone

Employment Information
Choose Payment Plan

accept marks

Select your payment method

Propane Usage

Agree to Terms & Personal Guarantee

*CREDIT TERMS AND CONDITIONS: Customer agrees to pay all fees, rates and charges within 15 days of the invoice date to George Propane, Inc. If Customer fails to pay any fees, rates and charges when due, George Propane, Inc., may add a finance charge of 1.5% per month (18% annually) to all past due balances. George Propane, Inc reserves the right to require payment in advance. If George Propane, Inc. files suit against Customer to enforce any of the terms and conditions of this Agreement or to recover possession of any of its equipment, the Customer shall pay George Propane, Inc. reasonable costs, including attorney's fees to the maximum extent permitted by law. Under no circumstance will a credit report be directly or indirectly accessed by, or passed on to, any other business entity or individual unrelated to George Propane, Inc., or be used for any other permissible purpose other than for evaluating the credit worthiness of new customers to extend net 15 day credit for the purchase of propane and/or heating and plumbing services.
I/We fully understand your credit terms and agree to the proper payment in consideration of extended credit. I/We hereby certify that the facts set forth in the above application are true and complete to the best of my/our knowledge. If George Propane, Inc. chooses to verify any of the information provided above, you are hereby authorized to make any investigations concerning my financial standing and/or credit record, or the financial standing and/or credit record of any principals listed above, through any investigative or credit agencies. I/We further acknowledge that credit privileges, if granted, may be withdrawn at any time.

I/We fully understand your credit terms and agree to the proper payment in consideration of extended credit.

I/We hereby certify that the facts set forth in the above application are true and complete to the best of my/our knowledge.

If George Propane, Inc. chooses to verify any of the information provided above, you are hereby authorized to make any investigations concerning my financial standing and/or credit record through any investigative or credit agencies.

I/We further acknowledge that credit privileges, if granted, may be withdrawn at any time.

*PERSONAL GUARANTEE: In consideration for George Propane, Inc. extending credit to the business identified below for any materials and/or services after this date at the request of applicants or its agents, the undersigned individual(s) hereby personally guarantee unconditionally and irrevocably the prompt payment of any sums now or hereafter owed to George Propane, Inc. by the business identified above whether said sums are due under open account, contract, or otherwise.

It is understood and agreed that credit, if extended, is to be on a continuing basis and may exceed estimated maximum credit limit required as state above. George Propane, Inc. shall not be obligated to notify the undersigned of the dates or amounts of any such credit and the undersigned waives demand, notice of default and any extension of time or any other forbearance which may be extended by George Propane, Inc.
This guaranty shall continue in force until notice in writing, sent by registered or certified mail, return receipt requested, is received by George Propane, Inc. Said notice shall specify the date on which this guaranty is to be terminated, said date not to be less than seven (7) days after such notice is received. Such termination shall in no way release the undersigned as to any sum or debt incurred prior to such termination.

Before submitting please make sure of the following

  • All necessary information has been filled out.
  • All information is error-free.
  • All information is correct and fraud-free.
  • That you have downloaded & filled out any PDF forms that are required.
  • For Fraud Prevention purposes, we have recorded your IP Address & the time of your submission.