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508-252-3359 or 888-272-3359

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Applicants

Last Name:
First Name:
MI:
Date of Birth:

Co Applicants

Last Name:
First Name:
MI:
Date of Birth:

Propane Delivery Address

Street:
APT #:
City:
State:
ZIP:
	Own Rent
How Long at Address:	Years
Landlord Name:
Daytime Phone:
Evening Phone:
Email Address:
Fax Number:

Mailing Address (if different)

Street:
APT #:
City:
State:
ZIP:

Previous Address (if less than 2 years at above address)

Street:
APT #:
City:
State:
ZIP:
	Own Rent
How Long at Address:	Years
	Landlord Mortgage Holder

How did you hear about Propane Plus?

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PROPANE EQUIPMENT – COMPANY OWNED Upon credit approval of Applicant, and Co-Applicant, if jointly occupied (hereinafter referred to as “Customer”), Propane Plus Corp. (PPC) agrees to install on the premises of Customer, the following equipment and related appurtenances for propane service: propane tank, base and regulators as required. (Hereinafter referred to as “Equipment”). In consideration for the installation/service of said Equipment, Customer agrees to the following terms: Annual Tank Rental: PPC charges a rental of $9.00 a month billed quarterly (every three months) for the prior quarter. Equipment: All Equipment owned by PPC will remain the property of PPC. From time to time, PPC may change the Equipment to coincide with Customer usage and government regulations. The authorized representative of PPC will be allowed necessary access at any time to inspect, service, remove, replace or move any part of the Equipment owned by PPC. Only authorized representatives of PPC will deliver propane, provide service, and have contact with the Equipment. Customer agrees to keep the area around the Equipment free of landscaping, debris and other hazards, including animals, which may damage the Equipment or cause injury to PPC’s authorized representative. Customer will not in any way alter, deface or destroy any of the Equipment. Customer agrees to notify PPC immediately if Customer believes there may be a problem with the Equipment, such as, but not limited to, a gas odor, leak, puncture or other potential hazard. Price & Fees: The prices charged for the propane and service will vary periodically based on market conditions and other factors. There may be a special/off-route delivery fee applicable, as well as a transfer fee and/or removal fee. Other fees and charges may also apply. A complete schedule of charges is available for Customer’s review at the offices of PPC. Billing: The propane delivery ticket left by the delivery driver is your bill unless prior arrangements have been made, or you are paying C.O.D. For all service/installations, payment is due at the time the service is rendered. Statement Fee: A statement fee will be added to each statement for any balance over 45 days old to partially offset the cost involved in collecting overdue balances. Terms (Not applicable to C.O.D.): Payments not received within 30 days after the delivery are subject to finance charges of 2% (24% Annual Percentage Rate). The minimum finance charge is $.50. Finance charges are computed until the date payment is received and begin on the date of service or delivery. Force Majeure Clause (Beyond Control of Either Party): If PPC is prevented from completing performance of any or all of its obligations under this Agreement by an act of God, the conduct of third parties, or any other occurrence beyond its control, then PPC shall be excused from performance as long as it is reasonably necessary to complete performance. Indemnification; Damages: Customer releases, indemnifies, defends and holds PPC, its officers, directors, employees, authorized representatives, successors and assigns harmless from any and all demands, claims, liability, expenses and damages (“Claims”) resulting from or caused by action or inaction which affects the proper function of the Equipment, unauthorized contact, use or servicing of the Equipment. PPC will not be responsible for any damages, claims, liability, losses or expenses resulting from the exhaustion of Customer’s propane supply. Customer agrees to provide said indemnification and defense within ten (10) days of PPC’s written notice to Customer of such Claim. This provision will survive termination or cancellation of this Agreement. Taxes; Security Deposits: Customer will be solely responsible to pay all taxes imposed on all sales and services under this Agreement, whether or not billed by PPC. Security deposits shall not earn interest unless required by law. Delivery and Service Suspension: Delivery and services may be suspended if payment in full is not made within 30 days after a delivery. The Customer will also incur an additional charge to resume service. Regulatory Compliance Charge: A regulatory compliance charge charge will be added to each delivery to partially offset the cost of meeting significant regulatory compliance issues facing our business, such as DOT, Homeland Security, Insurance, and DOL. Fuel Surcharge: A fuel surcharge will be added to each delivery to partially offset the cost of operating our vehicles and fuel surcharges imposed upon us by our shippers. Account Termination and Collection: An account may be referred to a collection agency and an account may be terminated and all PPC Equipment removed if payment in full is not received within 60 days after a delivery or service provided. Customer will be responsible for paying the past due balance, collection fees and attorney’s fees, as well as a service charge to remove the Equipment. If Customer chooses to terminate service with PPC, any balance on Customer’s account will become immediately due and owing. Equipment removal fees and/or termination fees may also apply. Returned Checks: All returned checks are subject to a bank charge and a PPC handling fee ($25.00) as allowable by law. A returned check may result in the loss of credit with PPC. Entire Agreement; Assignment: This Agreement is comprised of two pages and constitutes the entire understanding between Customer and PPC regarding the provision of propane and related services to Customer. PPC may assign this Agreement to its successors or affiliates at any time without written notice. This Agreement is not assignable by Customer without the written consent of PPC. No modifications to this Agreement may be made except in writing by PPC. By signing this Agreement, Customer consents to the evaluation of his/her credit history. Customer agrees to be subject to the terms of this Agreement and that purchase(s) will constitute acceptance of those terms. If Customer’s spouse does not also sign this Agreement, Customer represents that he/she is authorized to sign this Agreement on behalf of his/her spouse. PPC may also report Customer’s credit performance under any agreement entered into with PPC. Customer agrees PPC may request a consumer credit report in connection with this application and Agreement, and upon request, PPC will inform Customer of the name and address of the consumer reporting agency furnishing the credit report.

	I have read the above information and agree to the written stipulations above.

Conveniently located on Rt. 44 in Rehoboth
PO Box 38, 177 Winthrop St.
Rehoboth, MA 02769
Ph: 508-252-3359 | Toll Free: 888-272-3359 | Fax: 508-252-9944