Billing Information:
Fields marked * are required.

Full Name: *

Social Security/Tax ID No. : *

Full Name:

Mailing Address: *

City, State, Zip: *

Home Phone: *

Work Phone:

Email Address: *

Third Party Notification:

Delivery Address: *

Delivery City, State, Zip: *

County: *

Installation type:

1. This agreement supersedes any previously existing agreement between customer and DiSanto Propane.

2. Do not sign this Agreement before you read it or if it contains any blank spaces.

3. Fees and Finance Charges are subject to change. A current Fee Schedule is available upon request.

I (we) agree to be subject to the terms disclosed in the credit or purchase agreement when issued and any purchases will constitute my/our acceptance of those terms. We hereby certify that the information provided above and any attachments included herein are true and correct and are furnished for the purpose of inducing DiSanto Propane to extend credit to the undersigned. Applicant(s) authorizes DiSanto Propane to obtain a credit report in connection with this application and any update renewal, modification, collection or extension of the credit and authorizes DiSanto Propane to report my/our performance under this agreement or any other agreement I/we may have entered into with DiSanto Propane to any credit reporting agency and to answer any questions regarding my/our credit history with DiSanto Propane. Upon request, DiSanto Propane will inform Applicant of the name and address of any credit reporting agency which furnished a report.

APPLICANT SIGNATURE
Sign this application by completing the boxes below:

Applicant Signature: *

Date of Application: *

Understanding and
Agreement: *

TERMS AND CONDITIONS:

A. DiSanto Propane bills will be paid within 20 days of the invoice date to avoid a FINANCE CHARGE.

B. If I do not pay my Open Account total due within the time specified above:

1. A FINANCE CHARGE (Time Price Differential) may be computed on the unpaid Average Daily Balance. I will pay a FINANCE CHARGE determined by multiplying the Average Daily Balance by the appropriate periodic rate of 1.5% per month (ANNUAL PERCENTAGE RATE 18.0%) Buyer agrees to pay a minimum FINANCE CHARGE of $4.00 per month.

2. A SHUTOFF of my gas supply may occur.

3. A SPECIAL TRIP CHARGE will be made for run outs or turning my gas service back on.

4. A DEPOSIT or COD may be required.
 

C. I understand that the tanks, regulators, blocks and other special equipment installed by DiSanto Propane for my use is the property of DiSanto Propane and TITLE TO THAT EQUIPMENT remains with DiSanto Propane. While I am using this equipment I agree that:

1. I will not tamper with or move this equipment.

2. I will not allow anyone else to service, put gas in or use this equipment

3. I will notify DiSanto Propane when any appliances connected to this service are added, removed or replaced.

4. DiSanto Propane has reasonable access to it’s equipment for service, maintenance or removal.
 

D. I understand that it is the policy of DiSanto Propane to have all customers on automatic fill and DiSanto Propane will make every attempt to maintain a dependable supply of propane, however DiSanto Propane makes no warranties, nor assumes any liability for consequences if the system runs out of propane.

1. I agree to maintain access to the propane tanks in such a manner as to avoid undue risk, damage or injury to DiSanto Propane employees and equipment. Driveways and areas around the tank must be clear of snow and obstacles for us to make a delivery.

2. I understand that if an Off Route delivery is made because I have not met the terms and conditions of this agreement, I will pay a Special Trip Charge as per the Fee Schedule in effect at the time of the Off Route delivery

3. I acknowledge that vehicles used for the purpose of delivering my bulk propane can weigh as much as 33,000 lbs. and are 8 feet in width. I agree to maintain a suitable means of egress and that DiSanto Propane will not be liable for damage to my driveway.

4. I understand that if the premises to be served by DiSanto Propane is a seasonal dwelling or not continuously occupied, I must notify DiSanto Propane and agree to the terms of a DiSanto Propane addendum to this agreement.
 

E. I further agree that if I do not abide by the terms and conditions of this agreement I;

1. Waive any claim for loss, damage or injury which may result.

2. Will pay reasonable legal fees and collection cost incurred by DiSanto Propane to retrieve it’s property or collect overdue payments.
 

F. I understand that DiSanto Propane may discontinue gas service on all past due accounts.

G. Returns and Refunds: Upon termination of service covered by this agreement, DiSanto Propane will credit any gas remaining in the propane system at the price for which it was paid less an ACCOUNT HANDLING FEE of 15%. There is no fee charged to remove an empty propane system from your premises.

H. TERM: Service is terminable at will by either DiSanto Propane or customer. Termination shall occur when DiSanto Propane removes its equipment from your premises and all balances owing are paid.