New Account Credit ApplicationNew Account Credit ApplicationStep 1 of 425%Primary ApplicantName(Required) First Middle Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County of Residence(Required)Social Security Number(Required)Date of Birth(Required) MM slash DD slash YYYY Drivers License #(Required)Email Home PhoneCell Phone(Required)Present EmployerWork PhoneSpouse / Co-Applicant:Name First Middle Last Social Security NumberDate of Birth MM slash DD slash YYYY Drivers License #Email Home PhoneCell PhonePresent EmployerWork PhoneDow you Own or Rent?(Required) Own RentLandlord NameLandlord PhoneIs PROPANE your main heating source?(Required) Yes NoWhich program do you prefer? Keep Fill Will CallWhat size tank(s) do you currently have?(Required)How many gallons do you usually use annually?Skip of not applying for Propane Sales & Service.Check all items that use propane on your property Furnace Range Water Heater Dryer Fireplace Heater(s)Have the persons/business ever filed bankruptcy?(Required) Yes NoWhat are the dates of the bankruptcy?ReferencesPrevious Fuel / Utility Reference NameBank Reference NamePhoneFaxWith my signature below, I authorize the above references and credit bureaus to release our financial information to SCHAULS GAS INC.The above information is given for the purpose of establishing an account and is a true statement. In consideration for the extension of credit, purchaser agrees to the terms of sale set forth on each invoice and/or contract. Purchaser agrees to pay a service charge on all outstanding balances at the monthly rate of 1-1/2%. In the event collection is needed, purchaser agrees to pay all collection costs.SignatureCAPTCHAΔ