TYPE OF SERVICE

*See our Application & Forms page for relevant exemption forms.



APPLICANT INFORMATION
APPLICANT'S EMAIL*
PHYSICAL ADDRESS*


APPLICANT CREDIT REFERENCES (BANK OR OTHER OPEN ACCOUNT)
RELEASE AND VERIFICATION OF INFORMATION/ AGREEMENT /SIGNATURE(S)
Permission is hereby granted to Applicant's creditors listed above to release the information requested by Allied Propane Service concerning such accounts. If Applicant is issued Fuel Access Cards, Applicant agrees to be bound by all of the terms and conditions set forth in Allied's Fuel Access Card Agreement, which are incorporated herein as though set forth in full. If Applicant charges purchases of products, equipment, and/or services, Applicant agrees to pay for such products, equipmennt, and/or services according to the following terms: Net 30 days on each invoice. A late payment charge of 2% per month will be applied to amounts not paid when due. In the event that collection and/or enforcement efforts are commenced by Allied, Customer shall pay to Allied its collection and legal expenses, including expert fees and attorney fees (both prejudgment and postjudgment). Customer agrees that the venue for any action arising out of the collection and/or enforcement shall be in the state of California. If Applicant is a Corporation, the Principals signing below agree to guarantee payment of any and all indebtedness of the Applicant to Allied and agree to be bound by the above terms and conditions. Applicant verifies that the information above is true and correct to the best of Applicant's knowledge.
NAME OF PRIMARY SIGNATORY