Customer Owned Tank Agreement

Customer Owned Tank Agreement
Customer Owned Tank Affidavit
Name

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Telephone*

Area CodePhone Number
Work Telephone

Area CodePhone Number
Propane Tank Information
Serial Number
Manufacturer
Tank Size (Gross Capacity)
Year
Date

MonthDayYear
Date
Signature*

Clear
SERVICE TECHNICIAN INFORMATION

****FOR CC PROPANE / OFFICE USE ONLY - DO NOT FILL OUT THIS SECTION****
SERVICE TECHNICIAN NAME

First NameLast Name
I verify that the above information is true and correct to the best of my knowledge.
Date

MonthDayYear
Date
Service Tech Signature

Clear
Should be Empty:

Propane Tank Information