New Account Credit Application

Please select an account type.

Propane Sales and Service

Service Work on HVAC and Appliances

Both (Propane and Service)

Propane Sales & Service

There is an existing Schauls Gas Inc. tank on my property

I own the propane tank at this property and have proof of ownership

There is a propane tank onsite which I would like to have replaced with a leased Schauls Gas Inc. tank

The property does not have an existing propane tank, so I need to lease a tank from Schauls Gas Inc.

Primary Applicant

Name(Required)

First Middle Last

Service Address(Required)

Street Address Address Line 2 City State ZIP Code

Is your mailing address the same as the service address?(Required)

Yes

No

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

County property is located(Required)

Town, City or Village of:

Social Security Number(Required)

Date of Birth(Required)

Drivers License #(Required)

Email

Home Phone

Cell Phone(Required)

Present Employer

Work Phone

Spouse / Co-Applicant:

Name

First Middle Last

Social Security Number

Date of Birth

Drivers License #

Email

Home Phone

Cell Phone

Present Employer

Work Phone

Have the persons/business ever filed bankruptcy?(Required)

Yes

No

What are the dates of the bankruptcy?

References

Previous Fuel / Utility Reference Name

Bank Reference Name

Phone

Fax

With 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.

Signature