Propane Tank Set Questionnaire
Customer Name
Invalid Input
Address
Invalid Input
Address 2
Invalid Input
City & State
Invalid Input
Postal Code
Invalid Input
County
Invalid Input
Township
Invalid Input
Name of Landlord
Invalid Input
Landlords phone number
Invalid Input
Home Phone Number
Invalid Input
Cell Phone Number
Invalid Input
Work Phone Number
Invalid Input
Delivery Address
Invalid Input
Delivery Address #2
Invalid Input
Delivery City and State
Invalid Input
Delivery Postal Code
Invalid Input
Co-Application First Name
Invalid Input
Co-Applicant Last Name
Invalid Input
Size of Tank
Invalid Input
Delivery Account Type
Invalid Input
# Additional Delivery Type Information
Invalid Input
Credit Rating
Invalid Input
Estimated Annual Gallons (for budget only)
Invalid Input
First Service Date Requested (format mm-dd-yyyy)
Invalid Input
Customer Email Address
Invalid Input
Gallons to be Delivered
Invalid Input
Price Quoted
Invalid Input
Customer Type
Invalid Input
Residence Type
Invalid Input
Commercial
Invalid Input
Tank Set Type
Invalid Input
Current Supplier
Invalid Input
Will we be connecting to multiple buildings? (if so, how many)
Invalid Input
If switchout, will our tank go in the same place?
Invalid Input
If switchout, what is the percentage left in the tank?
Invalid Input
Tank location
Invalid Input
Please stake a spot for review, review rules with customer 10' stake within 100' of where delivery truck will park, drier must be able to see tank from parking spot.
If new, give approximate distance from tank location to gas piping on outside of house
Invalid Input
Appliances on Propane? (check all that apply)
Invalid Input
Are appliances ready to test?
Invalid Input
Electricity in the house?
Invalid Input
Is there power to all appliances?
Invalid Input
Alternative sources for heat?
Invalid Input
Small Tank Access
Invalid Input
Is black piping complete?
Invalid Input
Is black piping stubbed outside of house above ground?
Invalid Input
Are regulators accessible? (no decks or building blocking)
Invalid Input
Is final grade complete?
Invalid Input
Will someone be home?
Invalid Input
Does Miss Dig need to be called? (explain we will call)
Invalid Input
Are there any pets/animals that need to be secured?
Invalid Input
Review trenching waiver
Invalid Input
Explain "no set policy"
Invalid Input
Additional comments/instructions
Invalid Input
CSR Email to receive report (*)
Invalid Input