Discount Heating Oil Prices

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PILGRIM PROPANE GROUP
TEL: 1-800-774-0062
FAX: 1-888-267-3897

NEW CUSTOMER REGISTRATION - PROPANE GAS

Residential
Commercial

Last Name: First Name:

Delivery Address: Located Between:

City: State: Zip:	SPECIAL INSTRUCTIONS
Billing Address: Same as delivery address
City: State: Zip:
Telephone: Home: Work:
E-mail Address:

Former propane supplier: Date of last delivery: / /

Do you have a dog in yard? Yes No Do we need a key for gate or door? Yes No

Propane tank size Other: Approximate propane consumed per year:

Type of delivery: Automatic Will-call
Do you have an underground propane tank? Yes No

Where is your propane tank?

Do you own your own propane tank? Yes No

What do you use propane for? Heating Hot Water Air-Conditioner
Cooking\Grilling Swimming Pool Generator Fireplace Dryer

Payment type: Cash Check Credit Card

Credit Card # (last 4 digits): EXP. Date: / Visa MC Discover AMEX

Automatic Credit Card Deduction on all deliveries: Yes No

Charge my Credit Card one time (1x): Yes No

Your name:
I authorize Pilgrim Oil Group and it's suppliers to check my credit rating if I decide to pay by check.