Business Application Business Application "*" indicates required fields Check One:* Sole Proprietor Corporation Partnership LLC Business Name:* EIN#/BIN#*Contact Person for Business:* Phone:*Email Address:* Mailing Address* City, State, Zip* Delivery Address* City, State, Zip* Office Phone:*Office Fax:All Applicants - Complete rest of information below & sign.How long at delivery address listed above?* Years Months Zero time If Zero time above, please clarify:* Just moved in Will be moving in Date* MM slash DD slash YYYY Prior address (if less than 1 yr at delivery address):Check which one applies at the DELIVERY ADDRESS listed above:* I Own Property Second I Rent Property Previous property owner's name:* Landlord's Name:* Landlord's Phone:* Landlord's Address:* Street Address Previous propane supplier at Delivery Address:* Is there a tank at the delivery location?* Yes No - I need a tank set What size is the tank?* 500 gallon 1000 gallon Other List*Who owns the tank?* I own Landlord owns B&B owns Another Company Owns What size of tank do you want set?* 500 gallon 1000 gallon Other List*Propane will be used for:* Furnace Dryer Gas Fireplace Stove Hot Water Heater Other List* Do you burn wood?* Yes No Do you have a wood burning fireplace?* Yes No How did you hear about B&B Propane? Consent* I (we), the undersigned individual(s), hereby authorize B&B Propane to obtain my (our) credit report to assist in making necessary informed credit decisions and understand my (our) report may be obtained anytime to make credit decisions regarding my (our) account. I (we) recognize credit history may be a factor in any credit decisions. I (we) understand B&B Propane may report to credit agencies my (our) account information once established. By signing below, I (we) agree to the terms and conditions. Customer Signature* Date* MM slash DD slash YYYY Δ
