Consumer Account Application & Agreement

You may either complete the online below and submit, or if you prefer, complete our handy fillable pdf form here, save it and either fax or email it to us.

Fields marked with * are required.

In order to have charge privileges, either a consumer credit application or commercial credit application must be completed and approved as per our credit policy. Our payment options provide several options to keep your account in good standing.

Terms and Conditions

CUSTOMER INFORMATION
* Applicant's Full Name
Email Address
* Primary Phone
Fax
* Full Mailing Address
Full Service Address Address where services are to be provided if different from mailing address.
Co-Applicant's Full Name
Co-applicant's email If different from above.
Co-Applicant's Primary Phone Number If different from above.
Co-applicant's Fax Number If different from above.
BANK INFORMATION
* Bank
* Bank's Full Mailing Address
Phone number
Account Number
How long at this branch ( years )
PERSONAL INFORMATION
* Applicant's Date of Birth Please enter your date of birth in the following format: MM / DD / YYYY
* Employer
* Years of service
* Gross Monthly Salary
Additional Income Indicate in dollars per month or per year.
Co-applicant's date of birth Please enter your date of birth in the following format: MM / DD / YYYY
Co-applicant's former address if less than 2 years.
Co-applicant's Employer
Do you own or rent your home?	Rent Own
If rent, Landlord's name
Landlord's phone number
Services Requested Check all products/services requested on account.	Propane Petroleum Feed Crop Inputs Other
* Go Green Initiative Help us go green - receive your statements by email!	Yes - please send via email. No
* Apply for credit By entering your name(s) and clicking "Apply for Credit", you: 1) have read, understand and agree to the terms and conditions stated, 2) are signing this application electronically, 3) agree your electronic signature is the legal equivalent of your manual signature, and 4) agree to the terms and conditions stated.	Agree Not Agree
* Date Please enter today's date in the following format: MM/DD/YYYY