Propane Service Signup

COLLETT PROPANE

Customized To Your Specific Needs

There’s a reason 98% of our customers would refer us to friends and family. Let us know a little about you and your needs through our streamlined propane service signup and we’ll build a package that best fits your needs, budget, and schedule. Once the forms are completed, a Collett representative will contact you in 24-48 hours. If you would like a hard copy to fill out, please call the office at 937-372-9194.

Let’s get started. Please select the option that best fits you.

I am a new customer,

and I would like to purchase the tank

I am a new customer,

and I would like to lease the tank

I am a new customer,

and I own my own tank

I am a new customer,

and there is a Collett tank already at my home or business

I am a new customer,

commercial/business

1New Customer Application

2Delivery Options

3Permission to Fill

New Customer Application

Name(Required)

First Last

Date of Birth(Required)

Driver's License #(Required)

Social Security #/Tax ID

Company Name

Phone(Required)

Email(Required)

Street Address(Required)

Zip / Postal Code(Required)

City(Required)

State(Required)

Service Address (if different)

County(Required)

Sq. Ft. of Home(Required)

Does the Property Have Any Special Delivery Requirements? (i.e. dogs, gates, etc.)(Required)

Property Ownership(Required)

I Own Property

I Rent Property

Landlord Name(Required)

Landlord Phone(Required)

Previous Address(Required)

Employer(Required)

Employer Phone(Required)

How long?(Required)

Is your credit currently frozen?(Required)

Yes

Please Note: If “Yes” above, your credit needs to be unfrozen to process this application.

Have you had an account with Collett Propane previously?(Required)

Yes

What will you be using propane for? (Check all that apply)(Required)

Commercial

Grain

Furnace

Cooking

Hot Water

Dryer

Pool

Logs

Generator

Shop/Garage Heat

Preferred method of contact?(Required)

Home / Cell / Work Phone

Agreement & Signature(Required)

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that my credit will be checked by CBC Credit Services and if I am approved for services, any false statements, omissions, or other misrepresentations made by me on this application may result in immediate account termination.

I agree

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Our Policy: It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Delivery Options

Pick a Delivery Option(Required)

AUTOMATIC FILL (Auto-Fill) DELIVERY OPTION – (CREDIT APPROVAL REQUIRED)

WILL-CALL DELIVERY OPTION

Automatic Fill means we will automatically refill your tank on a set, repeating schedule. We base this schedule on weather and usage history during the winter months. Once the Auto-Fill choice has been made, the account must remain on Auto-Fill for one-year. The account will remain on Auto-Fill until the CUSTOMER notifies Collett Propane to be removed from the Auto-Fill Program.

This option is for WINTER MONTHS ONLY (August 1 – May 1). No automatic deliveries are made during the summer months. Auto-Fill customers may contact us to request a fill in the summer when prices are traditionally lower.

Deliveries to customers with PAST DUE BALANCES are suspended. If a delivery is skipped because of a balance due, the account MAY BE SUBJECT to additional fees in “out of gas” situations. Customers are responsible for all gas delivered while being delivered on Auto-Fill, even in the case of moving. If you plan to move, please notify Collett Propane BEFORE the next scheduled delivery.

Will-Call means you are responsible to check tank levels on your own and contact Collett Propane to order fuel. Collett Propane requests that you CALL WHEN THE TANK IS BETWEEN 20% - 30% to ensure timely delivery without disruption in service. Deliveries are NOT GURANTEED on the same-day. Collett Propane is in certain areas, during specific days of the week. You will be told IN WRITING of your delivery day. The order must be placed PRIOR to delivery day. Deliveries placed ON YOUR DAY, will have to wait UNTIL THE FOLLOWING WEEK. Emergency fees and Minimum Fill fees apply in certain circumstances:

MINIMUM FILL FEE - $50 – This happens when a customer orders fuel and DOES NOT meet a minimum fill requirement. Each tank has a different minimum fill amount. YOU WILL BE INFORMED by Collett Propane staff.

There are some fees that can accrue to any account. We list them here to help you avoid them:

Driveway Access Fee - $50 (if we have to come back a second time to make a delivery due to overgrowth of vegetation, untreated snow-covered driveways, un-leashed dogs or other obstructions).
Out of Gas Fee - $50 (applies to Will-Call customers or Auto-Fill customers with past-due invoices). When a tank RUNS OUT OF GAS, the $50 fee is added because a driver MUST conduct a leak check. DELIVERY HAPPENS ON YOUR REGULAR DELIVERY DAY. The customer MUST BE HOME for an out of gas delivery. Customers not home, will be subject to an ADDITIONAL FEE of $100 for a Service Technician to make a return trip to the home.
Emergency Fill Fees - $150 - $300 (This fee does not apply to Auto-Fill customers without past due balances.)

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Permission to Fill

I, _________________ (customer name/s) give Collett Propane, Inc. permission to fill my customer-owned tank.(Required)

Located at:(Required)

The tank serial number is _________________(Required)

It is a _________________ gallon tank(Required)

The tank is _________________ (Please select one)(Required)

Above Ground

Underground

Agreement & Signature(Required)

By signing this form, I hereby certify and warrant, under penalty of perjury, that I am the owner of the tank described above. I acknowledge that Collett Propane is relying on my representation that I own the tank and agree to indemnify and hold Collett harmless from and against any actions, claims, damages, or losses that may result to Collett for relying on my representation of ownership.

If available, I am attaching proof of ownership including copies of the purchase invoice.

I agree

Account Number

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Would you like to be added to our email list to receive upcoming promotions & service info?

Add me to the list!

This field is for validation purposes and should be left unchanged.

*Depending on size and usage, you may be required to purchase your tank.

1New Customer Application

2Delivery Options

3Propane Gas Service and Equipment Rental Agreement

New Customer Application

Name(Required)

First Last

Date of Birth(Required)

Driver's License #(Required)

Social Security #/Tax ID

Company Name

Phone(Required)

Email(Required)

Street Address(Required)

Zip / Postal Code(Required)

City(Required)

State(Required)

Service Address (if different)

County(Required)

Sq. Ft. of Home(Required)

Does the Property Have Any Special Delivery Requirements? (i.e. dogs, gates, etc.)(Required)

Property Ownership(Required)

I Own Property

I Rent Property

Landlord Name(Required)

Landlord Phone(Required)

Previous Address(Required)

Employer(Required)

Employer Phone(Required)

How long?(Required)

Is your credit currently frozen?(Required)

Yes

Please Note: If “Yes” above, your credit needs to be unfrozen to process this application.

Have you had an account with Collett Propane previously?(Required)

Yes

What will you be using propane for? (Check all that apply)(Required)

Commercial

Grain

Furnace

Cooking

Hot Water

Dryer

Pool

Logs

Generator

Shop/Garage Heat

Preferred method of contact?(Required)

Home / Cell / Work Phone

Agreement & Signature(Required)

I agree

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Our Policy: It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Delivery Options

Pick a Delivery Option(Required)

AUTOMATIC FILL (Auto-Fill) DELIVERY OPTION – (CREDIT APPROVAL REQUIRED)

WILL-CALL DELIVERY OPTION

There are some fees that can accrue to any account. We list them here to help you avoid them:

Driveway Access Fee - $50 (if we have to come back a second time to make a delivery due to overgrowth of vegetation, untreated snow-covered driveways, un-leashed dogs or other obstructions).
Out of Gas Fee - $50 (applies to Will-Call customers or Auto-Fill customers with past-due invoices). When a tank RUNS OUT OF GAS, the $50 fee is added because a driver MUST conduct a leak check. DELIVERY HAPPENS ON YOUR REGULAR DELIVERY DAY. The customer MUST BE HOME for an out of gas delivery. Customers not home, will be subject to an ADDITIONAL FEE of $100 for a Service Technician to make a return trip to the home.
Emergency Fill Fees - $150 - $300 (This fee does not apply to Auto-Fill customers without past due balances.)

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Propane Gas Service and Equipment Rental Agreement

Name(Required)

First Last

Street Address(Required)

Zip / Postal Code(Required)

City(Required)

State(Required)

Service Location(Required)

Tank sizing is based on estimated annual usage. To retain the following size tank, the minimum annual usage must be met.

TANK SIZE	ANNUAL USAGE REQUIRED
125 gallon	200 gallons required
250 gallon	400 gallons required
325 gallon	625 gallons required
325 gallon-underground	700 gallons required
500 gallon	800 gallons required
500 gallon-underground	1000 gallons required
1000 gallon	1600 gallons required
1000 gallon-underground	1800 gallons required

RATES CHARGED
Rates charged are based on volume used per year. Annually, accounts are analyzed and rates adjusted accordingly.

USE OF RENTAL TANK AND EQUIPMENT
Company is responsible for upkeep of rental tank and equipment. At no time can customer deny access to such tank or equipment. Company may terminate this rental agreement at any time if customer violates Terms and Conditions of this agreement.

NOTIFICATION OF OWNERSHIP CHANGE
Upon change of property ownership Customer agrees to notify Company. Rental tank and equipment will be reassigned to new owner. Any product, which remains in rental tank or equipment, is the responsibility of property owners.

DELIVERY CHARGE
Customer agrees to an additional charge for delivery when requesting less than a complete fill, delivery on a day other than scheduled route day or "Out of Gas" situation.

It is expressly understood and agreed that the data sheet set forth above and the terms and conditions printed on the reverse side of this form constitute the gas service and rental agreement between the parties.

It is understood and agreed between the Parties hereto that this agreement shall be governed by and construed under sections 1310.01 through 1310.78 of the Ohio Revised Code.

Customer specifically acknowledges receipt of a copy of this agreement and by this execution accepts the terms and provisions set forth on both sides hereof.

Terms & Conditions(Required)

DELIVERY OF LEASED EQUIPMENT; TITLE.

The liquefied petroleum gas storage tanks, appliances, meters, and other LP-Gas equipment described on the reverse side hereof is owned by COMP ANY and has been, or shall hereafter be
delivered into the possession and control of CUSTOMER at CUSTOMER'S given address. COMPANY delivers such personal property to CUSTOMER for the term, and upon the terms and
conditions, hereinafter described. Unless and until CUSTOMER shall have paid COMP ANY the agreed valuation set forth on the reverse side hereof in cash, in full, it is understood and agreed that title to the leased equipment shall at all times remain in COMPANY, and CUSTOMER'S interest in such property is limited to mere possession as a lessee subject to the terms of this agreement. CUSTOMER undertakes and agrees not to take any action, which would have the effect of concealing the fact of COMPANY'S title to such equipment and covenant to confirm the fact of COMP ANY'S unconditional title to such equipment to all third parties.

TERM.

It is understood and agreed between the PARTIES hereto that CUSTOMER may remain in possession and control of the leased equipment for so long as CUSTOMER is not in breach of or default under this agreement and that COMP ANY may terminate this agreement at anytime, upon the ground of CUSTOMER'S breach of or default in performance of the terms and conditions of this agreement and COMPANY may retake possession of the leased equipment without prior written notice toCUSTOMER. Notwithstanding anything foregoing to the contrary, either party may terminate this agreement at anytime upon thirty (30) days' written notice to the other and CUSTOMER will surrender the leased equipment to COMP ANY in a condition substantially equal to that at the time of delivery to CUSTOMER subject to normal wear and tear and the elements. Any such termination by CUSTOMER shall in no way limit the CUSTOMER'S accrued obligations to pay any and all monies due hereunder or limit the amount of any damage to the leased equipment occurring during CUSTOMER'S possession and control thereof and without any fault on the part of COMPANY.

LOCATION AND USE OF EQUIPMENT AND INGRESS AND EGRESS.

CUSTOMER shall not move the leased equipment from its position of delivery and installation, in case of stationary equipment. In the case of mobile equipment, CUSTOMER agrees to keep the leased equipment garaged or maintained at CUSTOMER'S specified address when not in mobile use, and to obtain the written consent of COMP ANY if such equipment is to be located elsewhere on a regular basis. CUSTOMER is to use COMPANY owned equipment for the storage of COMPANY'S liquefied petroleum gas only. CUSTOMER shall provide ingress and egress to CUSTOMER'S premises for the purpose of installation and removal of the leased equipment and will not place any barriers so that such ingress and egress is blocked or hampered.

RENTAL PAYMENTS AND CHARGES.

CUSTOMER agrees to pay COMP ANY rental for the leased equipment in the amount of and at intervals specified on the reverse side hereof. CUSTOMER shall pay specified rental or deposits in advance. Notwithstanding anything foregoing to the contrary, the amount of rental to be paid by CUSTOMER and the intervals of payment may be changed from time to time upon notice to CUSTOMER from COMPANY. CUSTOMER shall pay upon invoice all applicable service installation and other charges as specified from time to time including but not limited to charges for liquefied petroleum gas delivered to CUSTOMER (including deliveries made into CUSTOMER-owned storage or equipment) CUSTOMER agrees to pay to the respective Assessor or to COMPANY the amount of any and all personal property taxes assessed against CUSTOMER or COMPANY in connection with the ownership or possession of the leased equipment.

DEFAULT.

In the event of a breach of or default in performance of any of the terms and conditions of this agreement or failure to make any payments due hereunder by CUSTOMER, it is understood that COMPANY shall have the right to any action or remedy provided by law as well as any action or remedy as set forth herein. The venue for any action that may be brought by either party to enforce the terms and provisions of this agreement shall be the court having jurisdiction of the subject matter in the county where the leased equipment is located at the time of the controversy. A waiver by COMP ANY of any breach or non-performance by CUSTOMER hereunder will not be considered as a waiver of any other of further breach or non-performance in the event it is necessary to bring an action to enforce the terms and conditions of this agreement of any payments hereunder, the prevailing party shall be paid its costs of each action and reasonable attorney fees, by the other.

LOSS OF OR DAMAGE TO LEASED EQUIPMENT.

By the execution of this agreement and the acceptance of delivery and installation of the leased equipment, CUSTOMER covenants and agrees to assume full responsibility for the protection and safekeeping of the leased equipment until redelivered to COMPANY or for COMPANY'S account at COMPANY'S request. CUSTOMER covenants to pay to COMPANY the valuation, specified by COMPANY, in the event of the loss of total destruction of the leased equipment-through no fault of COMPANY, or upon the occasion of CUSTOMER'S inability to surrender up such equipment upon any termination of this agreement. CUSTOMER likewise covenants and agrees to reimburse COMPANY in the amount of any repairable damage to the leased equipment while in CUSTOMER'S possession where occasioned through no fault of COMPANY.

SERVICE MAINTENANCE AND ALTERATION.

CUSTOMER covenants and agrees not to disturb or tamper with the leased equipment following its installation by COMPANY and during the continued term of this agreement. CUSTOMER'S activity being limited to the normal use and enjoyment of the leased equipment and not to service or repair thereto. In the event of the nonfunctional or malfunction of the leased equipment or any
portion thereof, CUSTOMER agrees to notify COMPANY at COMPANY'S nearest office immediately and to state the nature of the nonfunctioning or malfunction and request service in such connection. CUSTOMER agrees to prohibit and restrain all third parties fi:om interfering or tampering with the leased equipment in any manner, or disconnecting the same, except in case of emergency where circumstances dictate that the gas supply from the leased equipment be turned off. COMP ANY reserves the right to alter or change the size of the leased equipment from time to time when it is found necessary to do so to fit CUSTOMER'S consumption rate or delivery schedules of COMPANY.

INDEMNIFIACTION.

CUSTOMER hereby undertakes and agrees to indemnify and hold COMP ANY hannless from and against any and all claims, liabilities, damages, and expenses directly arising out of or in
connection with CUSTOMER'S possession and control, storage, use, or handling of the leased equipment at any time during the continued term of this lease and prior to redelivery to COMPANY,
unless such claims, liabilities, damages, or expenses are directly caused by the negligent omissions or commissions of COMPANY or COMPANY'S agents or employees. In the event of any claim or suit naming COMPANY and arising out of CUSTOMER'S possession and control, storage, use, or handling of the leased equipment during the term of this agreement. CUSTOMER agrees to undertake defense of the claim or action on behalf of COMP ANY or to reimburse COMP ANY in the amount of legal costs and reasonable attorney fees.

FORCE MAJEURE.

Neither party shall be liable in damages nor otherwise to the other for any failure to perform hereunder when performance is prevented, delayed or otherwise affected by or in connection with any embargo, order, requisition, or request of any government or acting authority. Act of God, fire, explosion, strike, industrial disturbance, accident, war, failure, loss, or impairment of COMPANY'S supplies at the shipping point designated herein, or facilities of production or transportation, or any other causes whatsoever beyond such party's control, whether or not similar to the causes enumerated herein. Notwithstanding the obligations of this contract COMP ANY may distribute its available supply of liquefied petroleum gas to a given location or in a stated area among its customers in such reasonable manner as it may determine and COMP ANY may similarly pass on cost increases received from its suppliers to CUSTOMER.

ASSIGNMENT AND NOTICE.

CUSTOMER shall not sublease any of the equipment leased to CUSTOMER hereby and shall not assign or transfer this agreement and the terms and conditions hereof without prior written consent of COMP ANY. CUSTOMER agrees to give notice of this agreement to all persons or entities that may have an interest in the premises where the leased equipment is located; both presently and at any time this agreement is in effect.

I agree

*Depending on size and usage, you may be required to purchase your tank.

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Would you like to be added to our email list to receive upcoming promotions & service info?

Add me to the list!

Name

This field is for validation purposes and should be left unchanged.

*Gas check fees may apply.

1New Customer Application

2Delivery Options

3Permission to Fill

New Customer Application

Name(Required)

First Last

Date of Birth(Required)

Driver's License #(Required)

Social Security #/Tax ID

Company Name

Phone(Required)

Email(Required)

Street Address(Required)

Zip / Postal Code(Required)

City(Required)

State(Required)

Service Address (if different)

County(Required)

Sq. Ft. of Home(Required)

What Percentage is Your Tank Currently On?(Required)

Does the Property Have Any Special Delivery Requirements? (i.e. dogs, gates, etc.)(Required)

Property Ownership(Required)

I Own Property

I Rent Property

Landlord Name

Landlord Phone

Previous Address(Required)

Employer(Required)

Employer Phone(Required)

How long?(Required)

Is your credit currently frozen?(Required)

Yes

Please Note: If “Yes” above, your credit needs to be unfrozen to process this application.

Have you had an account with Collett Propane previously?(Required)

Yes

What will you be using propane for? (Check all that apply)(Required)

Commercial

Grain

Furnace

Cooking

Hot Water

Dryer

Pool

Logs

Generator

Shop/Garage Heat

Preferred method of contact?(Required)

Home / Cell / Work Phone

Agreement & Signature(Required)

I agree

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Our Policy: It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Delivery Options

Pick a Delivery Option(Required)

AUTOMATIC FILL (Auto-Fill) DELIVERY OPTION – (CREDIT APPROVAL REQUIRED)

WILL-CALL DELIVERY OPTION

There are some fees that can accrue to any account. We list them here to help you avoid them:

Driveway Access Fee - $50 (if we have to come back a second time to make a delivery due to overgrowth of vegetation, untreated snow-covered driveways, un-leashed dogs or other obstructions).
Out of Gas Fee - $50 (applies to Will-Call customers or Auto-Fill customers with past-due invoices). When a tank RUNS OUT OF GAS, the $50 fee is added because a driver MUST conduct a leak check. DELIVERY HAPPENS ON YOUR REGULAR DELIVERY DAY. The customer MUST BE HOME for an out of gas delivery. Customers not home, will be subject to an ADDITIONAL FEE of $100 for a Service Technician to make a return trip to the home.
Emergency Fill Fees - $150 - $300 (This fee does not apply to Auto-Fill customers without past due balances.)

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Permission to Fill

I, _________________ (customer name/s) give Collett Propane, Inc. permission to fill my customer-owned tank.(Required)

Located at:(Required)

The tank serial number is _________________(Required)

It is a _________________ gallon tank(Required)

The tank is _________________ (Please select one)(Required)

Above Ground

Underground

Agreement & Signature(Required)

I agree

*Gas check fees may apply.

Account Number

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Would you like to be added to our email list to receive upcoming promotions & service info?

Add me to the list!

Name

This field is for validation purposes and should be left unchanged.

*If you are renting a home and your landlord leases the tank from us, you will be required to re-purchase your gas before a delivery is scheduled.

1New Customer Application

2Delivery Options

3Propane Gas Service and Equipment Rental Agreement

New Customer Application

Name(Required)

First Last

Date of Birth(Required)

Driver's License #(Required)

Social Security #/Tax ID

Company Name

Phone(Required)

Email(Required)

Street Address(Required)

Zip / Postal Code(Required)

City(Required)

State(Required)

Service Address (if different)

County(Required)

Sq. Ft. of Home(Required)

What Percentage is the Tank Currently On?(Required)

Does the Property Have Any Special Delivery Requirements? (i.e. dogs, gates, etc.)(Required)

Property Ownership(Required)

I Own Property

I Rent Property

Landlord Name(Required)

Landlord Phone(Required)

Previous Address(Required)

Employer(Required)

Employer Phone(Required)

How long?(Required)

Is your credit currently frozen?(Required)

Yes

Please Note: If “Yes” above, your credit needs to be unfrozen to process this application.

Have you had an account with Collett Propane previously?(Required)

Yes

What will you be using propane for? (Check all that apply)(Required)

Commercial

Grain

Furnace

Cooking

Hot Water

Dryer

Pool

Logs

Generator

Shop/Garage Heat

Preferred method of contact?(Required)

Home / Cell / Work Phone

Agreement & Signature(Required)

I agree

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Our Policy: It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Delivery Options

Pick a Delivery Option(Required)

AUTOMATIC FILL (Auto-Fill) DELIVERY OPTION – (CREDIT APPROVAL REQUIRED)

WILL-CALL DELIVERY OPTION

There are some fees that can accrue to any account. We list them here to help you avoid them:

Driveway Access Fee - $50 (if we have to come back a second time to make a delivery due to overgrowth of vegetation, untreated snow-covered driveways, un-leashed dogs or other obstructions).
Out of Gas Fee - $50 (applies to Will-Call customers or Auto-Fill customers with past-due invoices). When a tank RUNS OUT OF GAS, the $50 fee is added because a driver MUST conduct a leak check. DELIVERY HAPPENS ON YOUR REGULAR DELIVERY DAY. The customer MUST BE HOME for an out of gas delivery. Customers not home, will be subject to an ADDITIONAL FEE of $100 for a Service Technician to make a return trip to the home.
Emergency Fill Fees - $150 - $300 (This fee does not apply to Auto-Fill customers without past due balances.)

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Propane Gas Service and Equipment Rental Agreement

Name(Required)

First Last

Street Address(Required)

Zip / Postal Code(Required)

City(Required)

State(Required)

Service Location(Required)

Tank sizing is based on estimated annual usage. To retain the following size tank, the minimum annual usage must be met.

TANK SIZE	ANNUAL USAGE REQUIRED
125 gallon	200 gallons required
250 gallon	400 gallons required
325 gallon	625 gallons required
325 gallon-underground	700 gallons required
500 gallon	800 gallons required
500 gallon-underground	1000 gallons required
1000 gallon	1600 gallons required
1000 gallon-underground	1800 gallons required

RATES CHARGED
Rates charged are based on volume used per year. Annually, accounts are analyzed and rates adjusted accordingly.

DELIVERY CHARGE
Customer agrees to an additional charge for delivery when requesting less than a complete fill, delivery on a day other than scheduled route day or "Out of Gas" situation.

It is understood and agreed between the Parties hereto that this agreement shall be governed by and construed under sections 1310.01 through 1310.78 of the Ohio Revised Code.

Customer specifically acknowledges receipt of a copy of this agreement and by this execution accepts the terms and provisions set forth on both sides hereof.

Terms & Conditions(Required)

DELIVERY OF LEASED EQUIPMENT; TITLE.

The liquefied petroleum gas storage tanks, appliances, meters, and other LP-Gas equipment described on the reverse side hereof is owned by COMP ANY and has been, or shall hereafter be
delivered into the possession and control of CUSTOMER at CUSTOMER'S given address. COMPANY delivers such personal property to CUSTOMER for the term, and upon the terms and
conditions, hereinafter described. Unless and until CUSTOMER shall have paid COMP ANY the agreed valuation set forth on the reverse side hereof in cash, in full, it is understood and agreed that title to the leased equipment shall at all times remain in COMPANY, and CUSTOMER'S interest in such property is limited to mere possession as a lessee subject to the terms of this agreement. CUSTOMER undertakes and agrees not to take any action, which would have the effect of concealing the fact of COMPANY'S title to such equipment and covenant to confirm the fact of COMP ANY'S unconditional title to such equipment to all third parties.

TERM.

It is understood and agreed between the PARTIES hereto that CUSTOMER may remain in possession and control of the leased equipment for so long as CUSTOMER is not in breach of or default under this agreement and that COMP ANY may terminate this agreement at anytime, upon the ground of CUSTOMER'S breach of or default in performance of the terms and conditions of this agreement and COMPANY may retake possession of the leased equipment without prior written notice toCUSTOMER. Notwithstanding anything foregoing to the contrary, either party may terminate this agreement at anytime upon thirty (30) days' written notice to the other and CUSTOMER will surrender the leased equipment to COMP ANY in a condition substantially equal to that at the time of delivery to CUSTOMER subject to normal wear and tear and the elements. Any such termination by CUSTOMER shall in no way limit the CUSTOMER'S accrued obligations to pay any and all monies due hereunder or limit the amount of any damage to the leased equipment occurring during CUSTOMER'S possession and control thereof and without any fault on the part of COMPANY.

LOCATION AND USE OF EQUIPMENT AND INGRESS AND EGRESS.

CUSTOMER shall not move the leased equipment from its position of delivery and installation, in case of stationary equipment. In the case of mobile equipment, CUSTOMER agrees to keep the leased equipment garaged or maintained at CUSTOMER'S specified address when not in mobile use, and to obtain the written consent of COMP ANY if such equipment is to be located elsewhere on a regular basis. CUSTOMER is to use COMPANY owned equipment for the storage of COMPANY'S liquefied petroleum gas only. CUSTOMER shall provide ingress and egress to CUSTOMER'S premises for the purpose of installation and removal of the leased equipment and will not place any barriers so that such ingress and egress is blocked or hampered.

RENTAL PAYMENTS AND CHARGES.

CUSTOMER agrees to pay COMP ANY rental for the leased equipment in the amount of and at intervals specified on the reverse side hereof. CUSTOMER shall pay specified rental or deposits in advance. Notwithstanding anything foregoing to the contrary, the amount of rental to be paid by CUSTOMER and the intervals of payment may be changed from time to time upon notice to CUSTOMER from COMPANY. CUSTOMER shall pay upon invoice all applicable service installation and other charges as specified from time to time including but not limited to charges for liquefied petroleum gas delivered to CUSTOMER (including deliveries made into CUSTOMER-owned storage or equipment) CUSTOMER agrees to pay to the respective Assessor or to COMPANY the amount of any and all personal property taxes assessed against CUSTOMER or COMPANY in connection with the ownership or possession of the leased equipment.

DEFAULT.

In the event of a breach of or default in performance of any of the terms and conditions of this agreement or failure to make any payments due hereunder by CUSTOMER, it is understood that COMPANY shall have the right to any action or remedy provided by law as well as any action or remedy as set forth herein. The venue for any action that may be brought by either party to enforce the terms and provisions of this agreement shall be the court having jurisdiction of the subject matter in the county where the leased equipment is located at the time of the controversy. A waiver by COMP ANY of any breach or non-performance by CUSTOMER hereunder will not be considered as a waiver of any other of further breach or non-performance in the event it is necessary to bring an action to enforce the terms and conditions of this agreement of any payments hereunder, the prevailing party shall be paid its costs of each action and reasonable attorney fees, by the other.

LOSS OF OR DAMAGE TO LEASED EQUIPMENT.

By the execution of this agreement and the acceptance of delivery and installation of the leased equipment, CUSTOMER covenants and agrees to assume full responsibility for the protection and safekeeping of the leased equipment until redelivered to COMPANY or for COMPANY'S account at COMPANY'S request. CUSTOMER covenants to pay to COMPANY the valuation, specified by COMPANY, in the event of the loss of total destruction of the leased equipment-through no fault of COMPANY, or upon the occasion of CUSTOMER'S inability to surrender up such equipment upon any termination of this agreement. CUSTOMER likewise covenants and agrees to reimburse COMPANY in the amount of any repairable damage to the leased equipment while in CUSTOMER'S possession where occasioned through no fault of COMPANY.

SERVICE MAINTENANCE AND ALTERATION.

CUSTOMER covenants and agrees not to disturb or tamper with the leased equipment following its installation by COMPANY and during the continued term of this agreement. CUSTOMER'S activity being limited to the normal use and enjoyment of the leased equipment and not to service or repair thereto. In the event of the nonfunctional or malfunction of the leased equipment or any
portion thereof, CUSTOMER agrees to notify COMPANY at COMPANY'S nearest office immediately and to state the nature of the nonfunctioning or malfunction and request service in such connection. CUSTOMER agrees to prohibit and restrain all third parties fi:om interfering or tampering with the leased equipment in any manner, or disconnecting the same, except in case of emergency where circumstances dictate that the gas supply from the leased equipment be turned off. COMP ANY reserves the right to alter or change the size of the leased equipment from time to time when it is found necessary to do so to fit CUSTOMER'S consumption rate or delivery schedules of COMPANY.

INDEMNIFIACTION.

CUSTOMER hereby undertakes and agrees to indemnify and hold COMP ANY hannless from and against any and all claims, liabilities, damages, and expenses directly arising out of or in
connection with CUSTOMER'S possession and control, storage, use, or handling of the leased equipment at any time during the continued term of this lease and prior to redelivery to COMPANY,
unless such claims, liabilities, damages, or expenses are directly caused by the negligent omissions or commissions of COMPANY or COMPANY'S agents or employees. In the event of any claim or suit naming COMPANY and arising out of CUSTOMER'S possession and control, storage, use, or handling of the leased equipment during the term of this agreement. CUSTOMER agrees to undertake defense of the claim or action on behalf of COMP ANY or to reimburse COMP ANY in the amount of legal costs and reasonable attorney fees.

FORCE MAJEURE.

Neither party shall be liable in damages nor otherwise to the other for any failure to perform hereunder when performance is prevented, delayed or otherwise affected by or in connection with any embargo, order, requisition, or request of any government or acting authority. Act of God, fire, explosion, strike, industrial disturbance, accident, war, failure, loss, or impairment of COMPANY'S supplies at the shipping point designated herein, or facilities of production or transportation, or any other causes whatsoever beyond such party's control, whether or not similar to the causes enumerated herein. Notwithstanding the obligations of this contract COMP ANY may distribute its available supply of liquefied petroleum gas to a given location or in a stated area among its customers in such reasonable manner as it may determine and COMP ANY may similarly pass on cost increases received from its suppliers to CUSTOMER.

ASSIGNMENT AND NOTICE.

CUSTOMER shall not sublease any of the equipment leased to CUSTOMER hereby and shall not assign or transfer this agreement and the terms and conditions hereof without prior written consent of COMP ANY. CUSTOMER agrees to give notice of this agreement to all persons or entities that may have an interest in the premises where the leased equipment is located; both presently and at any time this agreement is in effect.

I agree

*If you are renting a home and your landlord leases the tank from us, you will be required to re-purchase your gas before a delivery is scheduled.

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

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*If you are renting a home and your landlord leases the tank from us, you will be required to re-purchase your gas before a delivery is scheduled.

1New Customer Application

2Delivery Options

3Propane Gas Service and Equipment Rental Agreement

New Customer Application

Name of Business

Tax/Federal ID(Required)

Billing Address(Required)

Zip / Postal Code(Required)

City(Required)

State(Required)

Service Address (if different)

Tax Exempt?(Required)

Yes

Years in Operation

Attach Form

Max. file size: 300 MB.

Point of Contact(Required)

Point of Contact Phone Number(Required)

Alt Point of Contact(Required)

Alt Point of Contact Phone Number(Required)

Are purchase orders needed?(Required)

Yes

Blanket PO #

What will you be using propane for? (Check all that apply)(Required)

Heat

Forklift

Pump Station

Restaurant

Other

Propane Use Other

Owners Name(Required)

First Last

SSN(Required)

Spouses Name

First Last

Spouses SSN

Address

Phone

Is business a Corporation or Partnership?(Required)

Corporation

Partnership

Corporation Officers Name

First Last

Corporation Officer Address

Phone

Corporation Officers Name

First Last

Corporation Officer Address

Phone

Corporation Officers Name

First Last

Corporation Officer Address

Phone

Owners Name

SSN(Required)

Spouses Name

SSN(Required)

Address

Phone

References

Trade

Address

Account Number

Phone

Trade

Address

Account Number

Phone

Trade

Address

Account Number

Phone

Trade

Address

Account Number

Phone

Agreement & Signature(Required)

This information is given for the purpose of obtaining credit and warranted to be true. You may make any such investigation in respect to my credit , as you deem necessary or advisable.

I agree to pay the balance I owe to Collett Propane, Inc within 30 days (30) of receiving my bill. I agree to pay finance charges that will accrue on the unpaid balance at a rate of 2% per mont (24% A.P.R.). I understand that legal action may be taken if I fail to fulfill this contract and I will be responsible for all collection costs including interest, filing fee, and responsible attorney fees.

Personal Guarantee: I hereby personally and unconditionally guarantee the payment of all merchandise and other charges incurred by the above reference's applicant.

Note: This form must be filled out completely in order for customer to receive a line of credit with Collett propane, Inc.

I agree

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

All information in this application is kept confidential.

Delivery Options

Pick a Delivery Option(Required)

AUTOMATIC FILL (Auto-Fill) DELIVERY OPTION – (CREDIT APPROVAL REQUIRED)

WILL-CALL DELIVERY OPTION

There are some fees that can accrue to any account. We list them here to help you avoid them:

Driveway Access Fee - $50 (if we have to come back a second time to make a delivery due to overgrowth of vegetation, untreated snow-covered driveways, un-leashed dogs or other obstructions).
Out of Gas Fee - $50 (applies to Will-Call customers or Auto-Fill customers with past-due invoices). When a tank RUNS OUT OF GAS, the $50 fee is added because a driver MUST conduct a leak check. DELIVERY HAPPENS ON YOUR REGULAR DELIVERY DAY. The customer MUST BE HOME for an out of gas delivery. Customers not home, will be subject to an ADDITIONAL FEE of $100 for a Service Technician to make a return trip to the home.
Emergency Fill Fees - $150 - $300 (This fee does not apply to Auto-Fill customers without past due balances.)

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Permission to Fill

Choose One

I am a commercial customer and I own my own tank

I am a commercial customer and I want to lease a tank

I, _________________ (customer name/s) give Collett Propane, Inc. permission to fill my customer-owned tank.(Required)

Located at:(Required)

The tank serial number is _________________(Required)

It is a _________________ gallon tank(Required)

The tank is _________________ (Please select one)(Required)

Above Ground

Underground

Agreement & Signature(Required)

I agree

Name(Required)

First Last

Street Address(Required)

Zip / Postal Code(Required)

City(Required)

State(Required)

Service Location(Required)

Tank sizing is based on estimated annual usage. To retain the following size tank, the minimum annual usage must be met.

TANK SIZE	ANNUAL USAGE REQUIRED
125 gallon	200 gallons required
250 gallon	400 gallons required
325 gallon	625 gallons required
325 gallon-underground	700 gallons required
500 gallon	800 gallons required
500 gallon-underground	1000 gallons required
1000 gallon	1600 gallons required
1000 gallon-underground	1800 gallons required

RATES CHARGED
Rates charged are based on volume used per year. Annually, accounts are analyzed and rates adjusted accordingly.

DELIVERY CHARGE
Customer agrees to an additional charge for delivery when requesting less than a complete fill, delivery on a day other than scheduled route day or "Out of Gas" situation.

It is understood and agreed between the Parties hereto that this agreement shall be governed by and construed under sections 1310.01 through 1310.78 of the Ohio Revised Code.

Customer specifically acknowledges receipt of a copy of this agreement and by this execution accepts the terms and provisions set forth on both sides hereof.

Terms & Conditions(Required)

DELIVERY OF LEASED EQUIPMENT; TITLE.

The liquefied petroleum gas storage tanks, appliances, meters, and other LP-Gas equipment described on the reverse side hereof is owned by COMP ANY and has been, or shall hereafter be
delivered into the possession and control of CUSTOMER at CUSTOMER'S given address. COMPANY delivers such personal property to CUSTOMER for the term, and upon the terms and
conditions, hereinafter described. Unless and until CUSTOMER shall have paid COMP ANY the agreed valuation set forth on the reverse side hereof in cash, in full, it is understood and agreed that title to the leased equipment shall at all times remain in COMPANY, and CUSTOMER'S interest in such property is limited to mere possession as a lessee subject to the terms of this agreement. CUSTOMER undertakes and agrees not to take any action, which would have the effect of concealing the fact of COMPANY'S title to such equipment and covenant to confirm the fact of COMP ANY'S unconditional title to such equipment to all third parties.

TERM.

It is understood and agreed between the PARTIES hereto that CUSTOMER may remain in possession and control of the leased equipment for so long as CUSTOMER is not in breach of or default under this agreement and that COMP ANY may terminate this agreement at anytime, upon the ground of CUSTOMER'S breach of or default in performance of the terms and conditions of this agreement and COMPANY may retake possession of the leased equipment without prior written notice toCUSTOMER. Notwithstanding anything foregoing to the contrary, either party may terminate this agreement at anytime upon thirty (30) days' written notice to the other and CUSTOMER will surrender the leased equipment to COMP ANY in a condition substantially equal to that at the time of delivery to CUSTOMER subject to normal wear and tear and the elements. Any such termination by CUSTOMER shall in no way limit the CUSTOMER'S accrued obligations to pay any and all monies due hereunder or limit the amount of any damage to the leased equipment occurring during CUSTOMER'S possession and control thereof and without any fault on the part of COMPANY.

LOCATION AND USE OF EQUIPMENT AND INGRESS AND EGRESS.

CUSTOMER shall not move the leased equipment from its position of delivery and installation, in case of stationary equipment. In the case of mobile equipment, CUSTOMER agrees to keep the leased equipment garaged or maintained at CUSTOMER'S specified address when not in mobile use, and to obtain the written consent of COMP ANY if such equipment is to be located elsewhere on a regular basis. CUSTOMER is to use COMPANY owned equipment for the storage of COMPANY'S liquefied petroleum gas only. CUSTOMER shall provide ingress and egress to CUSTOMER'S premises for the purpose of installation and removal of the leased equipment and will not place any barriers so that such ingress and egress is blocked or hampered.

RENTAL PAYMENTS AND CHARGES.

CUSTOMER agrees to pay COMP ANY rental for the leased equipment in the amount of and at intervals specified on the reverse side hereof. CUSTOMER shall pay specified rental or deposits in advance. Notwithstanding anything foregoing to the contrary, the amount of rental to be paid by CUSTOMER and the intervals of payment may be changed from time to time upon notice to CUSTOMER from COMPANY. CUSTOMER shall pay upon invoice all applicable service installation and other charges as specified from time to time including but not limited to charges for liquefied petroleum gas delivered to CUSTOMER (including deliveries made into CUSTOMER-owned storage or equipment) CUSTOMER agrees to pay to the respective Assessor or to COMPANY the amount of any and all personal property taxes assessed against CUSTOMER or COMPANY in connection with the ownership or possession of the leased equipment.

DEFAULT.

In the event of a breach of or default in performance of any of the terms and conditions of this agreement or failure to make any payments due hereunder by CUSTOMER, it is understood that COMPANY shall have the right to any action or remedy provided by law as well as any action or remedy as set forth herein. The venue for any action that may be brought by either party to enforce the terms and provisions of this agreement shall be the court having jurisdiction of the subject matter in the county where the leased equipment is located at the time of the controversy. A waiver by COMP ANY of any breach or non-performance by CUSTOMER hereunder will not be considered as a waiver of any other of further breach or non-performance in the event it is necessary to bring an action to enforce the terms and conditions of this agreement of any payments hereunder, the prevailing party shall be paid its costs of each action and reasonable attorney fees, by the other.

LOSS OF OR DAMAGE TO LEASED EQUIPMENT.

By the execution of this agreement and the acceptance of delivery and installation of the leased equipment, CUSTOMER covenants and agrees to assume full responsibility for the protection and safekeeping of the leased equipment until redelivered to COMPANY or for COMPANY'S account at COMPANY'S request. CUSTOMER covenants to pay to COMPANY the valuation, specified by COMPANY, in the event of the loss of total destruction of the leased equipment-through no fault of COMPANY, or upon the occasion of CUSTOMER'S inability to surrender up such equipment upon any termination of this agreement. CUSTOMER likewise covenants and agrees to reimburse COMPANY in the amount of any repairable damage to the leased equipment while in CUSTOMER'S possession where occasioned through no fault of COMPANY.

SERVICE MAINTENANCE AND ALTERATION.

CUSTOMER covenants and agrees not to disturb or tamper with the leased equipment following its installation by COMPANY and during the continued term of this agreement. CUSTOMER'S activity being limited to the normal use and enjoyment of the leased equipment and not to service or repair thereto. In the event of the nonfunctional or malfunction of the leased equipment or any
portion thereof, CUSTOMER agrees to notify COMPANY at COMPANY'S nearest office immediately and to state the nature of the nonfunctioning or malfunction and request service in such connection. CUSTOMER agrees to prohibit and restrain all third parties fi:om interfering or tampering with the leased equipment in any manner, or disconnecting the same, except in case of emergency where circumstances dictate that the gas supply from the leased equipment be turned off. COMP ANY reserves the right to alter or change the size of the leased equipment from time to time when it is found necessary to do so to fit CUSTOMER'S consumption rate or delivery schedules of COMPANY.

INDEMNIFIACTION.

CUSTOMER hereby undertakes and agrees to indemnify and hold COMP ANY hannless from and against any and all claims, liabilities, damages, and expenses directly arising out of or in
connection with CUSTOMER'S possession and control, storage, use, or handling of the leased equipment at any time during the continued term of this lease and prior to redelivery to COMPANY,
unless such claims, liabilities, damages, or expenses are directly caused by the negligent omissions or commissions of COMPANY or COMPANY'S agents or employees. In the event of any claim or suit naming COMPANY and arising out of CUSTOMER'S possession and control, storage, use, or handling of the leased equipment during the term of this agreement. CUSTOMER agrees to undertake defense of the claim or action on behalf of COMP ANY or to reimburse COMP ANY in the amount of legal costs and reasonable attorney fees.

FORCE MAJEURE.

Neither party shall be liable in damages nor otherwise to the other for any failure to perform hereunder when performance is prevented, delayed or otherwise affected by or in connection with any embargo, order, requisition, or request of any government or acting authority. Act of God, fire, explosion, strike, industrial disturbance, accident, war, failure, loss, or impairment of COMPANY'S supplies at the shipping point designated herein, or facilities of production or transportation, or any other causes whatsoever beyond such party's control, whether or not similar to the causes enumerated herein. Notwithstanding the obligations of this contract COMP ANY may distribute its available supply of liquefied petroleum gas to a given location or in a stated area among its customers in such reasonable manner as it may determine and COMP ANY may similarly pass on cost increases received from its suppliers to CUSTOMER.

ASSIGNMENT AND NOTICE.

CUSTOMER shall not sublease any of the equipment leased to CUSTOMER hereby and shall not assign or transfer this agreement and the terms and conditions hereof without prior written consent of COMP ANY. CUSTOMER agrees to give notice of this agreement to all persons or entities that may have an interest in the premises where the leased equipment is located; both presently and at any time this agreement is in effect.

I agree

*If you are renting a home and your landlord leases the tank from us, you will be required to re-purchase your gas before a delivery is scheduled.

Account #

Signature / Printed Name(Required)

Date(Required)

MM slash DD slash YYYY

Name

First Last

Would you like to be added to our email list to receive upcoming promotions & service info?

Add me to the list!

This field is for validation purposes and should be left unchanged.

Propane Service Signup

Customized To Your Specific Needs

I am a new customer,

I am a new customer,

I am a new customer,

I am a new customer,

I am a new customer,

New Customer Application

Delivery Options

Permission to Fill

*Depending on size and usage, you may be required to purchase your tank.

New Customer Application

Delivery Options

Propane Gas Service and Equipment Rental Agreement

*Gas check fees may apply.

New Customer Application

Delivery Options

Permission to Fill

*If you are renting a home and your landlord leases the tank from us, you will be required to re-purchase your gas before a delivery is scheduled.

New Customer Application

Delivery Options

Propane Gas Service and Equipment Rental Agreement

*If you are renting a home and your landlord leases the tank from us, you will be required to re-purchase your gas before a delivery is scheduled.

New Customer Application

References

Delivery Options

Permission to Fill

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