SOUTHLAND PROPANE CUSTOMER APPLICATION

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READ AND SIGN:

I agree to allow Southland Propane to deliver gas to our tank located at

I understand that gas may be delivered without my presence at the above-stated address and the driver will leave a gas ticket showing the amount of gas pumped into the tank.  I also agree that if for any reason I am billed, instead of prepaying, that I will pay in a timely manner.  Bill is due 10 days from delivery.  Unpaid balances are subject to late fees. I understand that I am responsible for all collection effort and fees, including but not limited to court costs, attorney fees and etc.  I understand that I am responsible for checking my tank and calling in a gas order when needed.  I understand that if I allow my tank to become empty that I will be charged a $25.00 service fee to do a pressure test on my piping system per Georgia State Fire Code.  I understand that if I am renting a tank from SOUTHLAND PROPANE SERVICE, INC. I am responsible for damage or theft while on my property.  I understand that if payment is not received on the due date, Southland Propane Service will take means to collect on any unpaid balance including cutting off the gas supply.  I understand that even if the tank is owned by me, the customer, the contents of the tank is owned by Southland Propane Services, Inc. until it is paid for in full and Southland Propane Services, Inc. reserves the right to protect and remove the product or tank from the location until it is paid for.  I understand that if this occurs there will be a reconnection fee.  I understand that the tank must be accessible for service, repair, or removal at all times.  I understand that Southland Propane Services, Inc is not responsible for any expenses to service, repair, or remove tank including but not limited to driveway damages, yard damages, etc.  I understand that there is a $35.00 service fee on all returned checks.  I agree in the event that I terminate service with Southland Propane Service, Inc. before the period of 18 months, I will pay a $75.00 fee upon termination to have the tank picked up from my property. I agree that there will be a monthly late fee charge until balance in paid in full.

A COPY OF THE DRIVER’S LICENSE IS REQUIRED FOR NEW ACCOUNT SETUP