Budget Plan Form - Southland Propane Service

The SELLER, subject to all the Terms and Conditions
agrees to sell and deliver and the BUYER (Below)

Name

Address

State

Deliver To

City

Zip

Phone Number

agrees to accept and pay for the fuel and other equipment and services as specified in
accordance with the Terms and Conditions on the reverse side and hereinafter provided.

Date

PAYMENTS

Initial Payment of $

payable to the SELLER. Starting one month from date of initial payment, BUYER agrees to make additional consecutive monthly payments of

each, up to and including

IF MONTHLY PAYMENTS ARE NOT MADE WHEN DUE

THIS AGREEMENT MAY BE CANCELLED BY SELLER ON TEN (10) DAYS NOTICE.

PRICE - It is agreed that all payments will be applied toward the payment of the purchase price of fuel and/or other services covered by this agreement; which will be SELLER'S Retail Posted Price in effect at time and place of delivery.

No collector will call. Send payments to SELLER'S Office.

DELIVERY - The fuel purchased hereunder will be delivered in accordance with SELLER's Automatic Delivery Service upon approval of the credit department.

Date

Plan NO.

Accepted

COMPUTATION OF MONTHLY PAYMENTS

Estimated Season's Requirements in Gallons

Estimated Season's Fuel Cost Based On

Today's Price of

Cents Per Gallon

Estimated Yearly Heating Cost

Approximate Monthly Payment

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