Customer Owned Tank Agreement
Customer Owned Tank Affidavit
Name
First Name
Last Name
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Service Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Telephone
*
-
Area Code
Phone Number
Work Telephone
-
Area Code
Phone Number
Propane Tank Information
Serial Number
Manufacturer
Tank Size (Gross Capacity)
Year
Date
-
Month
-
Day
Year
Date
Signature
*
Clear
Submit
SERVICE TECHNICIAN INFORMATION
****FOR CC PROPANE / OFFICE USE ONLY - DO NOT FILL OUT THIS SECTION****
SERVICE TECHNICIAN NAME
First Name
Last Name
I verify that the above information is true and correct to the best of my knowledge.
Date
-
Month
-
Day
Year
Date
Service Tech Signature
Clear
Should be Empty: