CUSTOMER CREDIT APPLICATION

PRINCE
CUSTOMER CREDIT APPLICATION
NAME
ADDRESS: (include mailing address if different)
CITY. STATE, & ZIP CODE
IN CITY LIMITS?Y
Y
N
HOW LONG HAVE YOU LIVED AT THIS ADDRESS?
Phone Numbers - Primary
Phone Numbers - Secondary
Email
HOW DID YOU HEAR ABOUT OUR COMPANY?
PREVIOUS PROPANE SUPPLIER
PROPANE APPLIANCES USED:

SELECT ALL
GAS PACK/FURNACE
TANKLESS WATER HEATER
FIRE LOGS
DRYER
COOKSTOVE/RANGE
GENERATOR
WALL HEATER
GRILL
OTHER
INTERESTED IN BUDGET BILLING?
PLEASE TYPE YES IF INTERESTED
INTERESTED IN PRE-BUY?
PLEASE TYPE YES IF INTERESTED
INTERESTED IN AUTO-BILL CREDIT CARD?
PLEASE TYPE YES IF INTERESTED
I WISH TO OPEN A CHARGE ACCOUNT WITH PRINCE GAS CO. I UNDERSTAND THAT THE TERMS ARE "NET' THIRTY DAYS FROM DATE OF PURCHASE. I FURTHER UNDERSTAND THAT A FINANCE CHARGE OF 1% PER MONTH WILL BE ADDED TO ALL ACCOUNTS PAST DUE. I ALSO AGREE THAT ANY FEES INCURRED IN COLLECTING MY ACCOUNT MAY BE ADDED TO THE BALANCE DUE.

Before digging of any kind, it is the homeowners responsibility to contact 811 to get all utility lines marked.
SIGNATURE

Clear
DATE

MonthDayYear
Date
PO BOX 101. 1506 E. RUTHERFORD ST. LANDRUM, sc 29356 (864)457-2490 EMAIL: PRINCEGASCOMPANY@GMAIL.COM
Should be Empty:

PRINCE