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Residential Account Setup Form and Credit App

Thank you for choosing us for safe, dependable propane service.

We look forward to getting your home connected quickly and safely.

To apply for a new residential account, simply complete this form. You may also request propane tank rental as part of your account setup.

Customers who want service options beyond Will Call with Cash-on-Delivery (COD) should select the credit application option to establish an account with additional delivery or payment options.

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Step 1 of 3

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Residential Customer Credit Application

District

Zip code*

Please select the UPG location nearest your delivery address:*

Locations*

How did you hear about us?

Primary Applicant

First Name*

Last name

Email*

Phone*

Is this a mobile number?*

What is your preferred method of contact?*

Will you need to lease a tank or tanks?

Would you like to apply for credit terms?

Please note – without credit terms, service is limited to Will Call with COD (prepayment).)

Primary Applicant Date of Birth*

Address Line 1*

City*

State*

Zip Code*

How long at this address?

How long at this address?*

Less than a year at this address?

PREVIOUS Street Address, City, State, Zip (if less than 1 year at current address)

Will propane delivery be made to a different address?*

Address Line 1*

City*

State*

Zip Code*

Do you have another delivery address to add?*

Address Line 1*

City*

State*

Zip Code*

Do you have another delivery address to add?*

Address Line 1*

City*

State*

Zip Code*

More than 3 Delivery Addresses? (You can provide additional delivery addresses to our customer service representative when we are ready to set up your account.)

Is mailing address different to delivery address?*

Address Line 1*

City*

State*

Zip Code*

IMPORTANT NOTICE TO CUSTOMER

1. The information supplied is accurate as of the date shown; 2. An investigation of all statements or other credit data herein and release of such information to DCC Propane, LLC or any of its subsidiaries, from any and all sources is authorized; 3. A release is granted to all parties from all liability for any damage that may result from furnishing information to you; 4. To recognize that your individual credit history may be a factor in the evaluation of this credit application; and, 5. Consent to and authorize the use of any external credit reporting information utilized by DCC Propane, LLC or any of its subsidiaries, from time to time as may be needed.

Signature*

Date*

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Existing Customer Services

Request a will call delivery

Residential Account Setup Form and Credit App

Thank you for choosing us for safe, dependable propane service.

Residential Customer Credit Application

Primary Applicant

IMPORTANT NOTICE TO CUSTOMER

CO-APPLICANT INFORMATION – All fields are required to have a co-applicant on the account.

IMPORTANT NOTICE TO CUSTOMER

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