Customer Onboarding Form
  Customer Information  
First Name: *
 
Last Name: *
 
Business or Residential Customer: *
 Business
 Residential
Business Name: *
 
Delivery Address: *
 
City: *
 
State: *
 
Zip Code: *
 
Has this been your address for less than 5 years? *
 Yes
 No
Previous Physical Address: *
 
City: *
 
State *
 
Zip Code: *
 
Is Billing Address Same as Physical Address?: *
 Yes
 No
Billing Address: *
 
City: *
 
State: *
 
Zip Code: *
 
Phone Number: *
 
Cell Phone Number: *
 
Email Address:
 
Please email me updates from Union Propane:
 Please email me updates from Union Propane:
Drivers License Number: *
 
State Issued: *
 
Social Security Number (This form is secure) *
 
  Employment Information  
Current Employer: *
 
Position: *
 
Employer Address: *
 
Employer City: *
 
Employer State: *
 
Employee Zip Code: *
 
Employer Phone Number: *
 
  Propane Information  
Will the Propane Tank being filled by Union Propane be owned or leased? *
 I own my propane tank.
 I lease my propane tank from Union Propane.
What is the propane tank serial number? *
 
Is the tank being filled above ground or underground? *
 
How many gallons does your propane tank hold? *
 
What size tank would you like to lease from Union Propane? *
 
Previous Propane Company: *
 
Are you interested in Union Propane's Automatic Fill program? *
 
I am signing this to show proof of ownership of the above identified tank. If available, I am attaching proof of ownership with copies of purchase invoice. This signature also authorizes Union Propane LLC to fill my propane tank when propane is purchased.
Proof of Tank Ownership:
 
Propane Tank Ownership Signature Required: *
 
 
 
 
 
Date *
 
  Lease Agreement:  
Is the customer the homeowner of the property? *
 Yes
 No
Homeowner Name: *
 
Homeowner Address: *
 
Homeowner City: *
 
Homeowner State: *
 
Homeowner Zip Code: *
 
Length of Lease is continuous until the lease agreement is terminated.   Customer Agrees   1. To identify and mark all underground utilities prior to service by Union Propane LLC.   2. To pay the annual fee of $50.00 for all leased tanks. (Fee will be waived if propane is filled in the tank annually and paid in full. Ex: 500 gallons for a 500 gallon tank, 330 gallons for a 330 gallon tank, 1000 gallons for a 1000 gallon tank)   3)  To pay all invoices within 15 days after delivery.   4)  Not to tamper, alter or relocate Company equipment.   5)  To provide safe and unobstructed access to Company equipment. Customer authorizes employees of the Company to enter Customer’s premises at any and all reasonable times to service equipment, deliver propane, and upon termination of this agreement, to remove said equipment from the premises.   6) The Company reserves the right to charge a tank “pump out/pick up fee” if service is terminated.   7)  To pay the Company the value of the equipment if it is lost, stolen or damaged during the term of this agreement.   8)  Customer agrees to pay all finance charges on past due accounts.   9)  Customers should notify the Company for delivery when tank reaches 20%. Special deliveries will be charged an extra delivery charge. Out-of-gas customers will be charged for a pressure/leak test. 10) ALL rental homes must also have the land owner’s signature accepting the terms of this agreement and agrees that if the Customer does not pay any outstanding debts then the land owner will be responsible. Company and Customer Mutually Agree: 1)  Customer is responsible for all permit fees and installation charges are non- refundable. 2)  Title to the equipment (including propane tank, blocks and regulators) covered by this agreement shall remain property of the Company. 3)  Union Propane LLC is not responsible for customer “freeze ups” due to erratic gas usage or inability to get to the Customer’s tank, due to other heat sources, weather, driveways not plowed, etc... 4)  Any failure of performance on the part of the Company shall be excused without liability when said failure results from accident, weather conditions, acts of God, fire, floods, labor disturbances, failure of suppliers of propane or any other cause beyond the reasonable control of the company.
Customer Authorization Signature: *
 
 
 
 
 
Date: *
 
Homeowner Signature: *
 
 
 
 
 
Date: *