Propane and Fuels Application(Secure Form)


Applicant Information

First Name:*
  MI:
Last Name:*(or Business Name)
Billing Address:*
Apt. #:
City:*
State:* Zip:*
Email Address:
911 Service Address:
Same as billing address
City:
State: Zip:
County where service is requested:*
Home Phone: *
- -
Work Phone:
- -
Cell Phone:
- -
Social Security Number:*
- -
Drivers License:*
State of Issuance:*
Birth Date:*
 
Employer:
Are you a former Blue Ridge Energy Propane and Fuels customer?*    Yes No
Are you renting or buying your existing residence?* Buy Rent
What date is your closing if buying or lease date if renting?*
Do you have an existing tank?*    Yes No
If propane, what size is your tank?

If fuel oil or kerosene, please enter the size of your tank:
Do you own your tank?*    Yes No
If you own your propane tank, Blue Ridge Energy requires proof of purchase, a signed Acknowledgement of Ownership agreement and a sytem leak check must be performed on your propane system by a Blue Ridge Energy service technician before we can deliver propane to your location.
Does Blue Ridge Energy need to install a tank at your property?*    Yes No
If yes, would you prefer an above ground or under ground tank?    Above Under

What type of delivery service would you prefer?*
Autofill
We will monitor the tank at your property through our prediction software and deliver when needed. Deliveries may be suspended if your invoices are not paid within terms. We will provide emergency deliveries with no same day delivery charges to an autofill customer in good standing if the tank at their property runs out of fuel.
Will Call
Call us when you want a delivery. Please allow 3-5 business days (or more during winter) for your delivery. After hours or other delivery charges will be assessed if you allow your tank to run out of fuel.

Please select if you are interested in any of the following programs:
Senior Citizens Discount
Military Discount
*Budget Billing
*Bank Draft
*Credit Card Draft
*Must be credit approved

Please list all propane appliances that you have or will have in your home:

Are you interested in purchasing any propane appliances from Blue Ridge Energy?    Yes No
If yes, please list any appliances you would be interested in purchasing:

If your home is not easily found via GPS or Google Maps, please provide additional driving instructions to your home. If you have an existing tank, please specify where the tank is located.

PREPAYMENT MAY BE REQUIRED FOR ALL DELIVERY AND SERVICE CALLS IF A CHARGE ACCOUNT CANNOT BE ESTABLISHED THROUGH A CREDIT CHECK. A BLUE RIDGE ENERGY REPRESENTATIVE WILL CONTACT YOU IMMEDIATELY SHOULD THERE BE A QUESTION IN ESTABLISHING YOUR ACCOUNT.

Additional Comments:

BY SUBMITTING THIS FORM, I CERTIFY THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. BLUE RIDGE ENERGY, LLC IS AUTHORIZED TO MAKE ANY AND ALL INQUIRIES NECESSARY FOR ACTION ON THIS APPLICATION. I HEREBY INDEMNIFY BLUE RIDGE ENERGY, LLC AND ITS AGENTS FROM ANY LIABILITY RESULTING FROM THEIR CREDIT SURVEY.

I UNDERSTAND THE BLUE RIDGE ENERGY, LLC TERMS ARE NET DUE- 30 DAYS AFTER DELIVERY OF PRODUCT AND AGREE TO MEET THESE TERMS IF CREDIT IS EXTENDED. BY SUBMITTING THIS FORM, I ALSO AGREE TO PAY ANY AND ALL FINANCE CHARGES, PENALTIES, OR COURT COSTS RESULTING FROM THIS ACCOUNT BEING DELINQUENT.

A FINANCE CHARGE OF 1.5% PER MONTH, WHICH IS AN ANNUAL PERCENTAGE RATE OF 18% WILL BE ADDED ON THE REMAINING UNPAID BALANCE OVER 30 DAYS OLD.


LP Gas Agreement

The following terms and conditions apply:

1. EQUIPMENT: Company will install and maintain equipment at Customer’s property. The propane tank(s) and equipment listed below will remain property of Company and will not become part of the real property where it is installed.

2. CUSTOMER RESPONSIBILITY (EQUIPMENT): Customer agrees to notify Company prior to any modifications being made to the residence or building that may affect Company’s equipment, delivery, or serviceability. Customer shall not make nor authorize any third party to make any modifications to the residence or building where the tank is located that could result in the tank location becoming out of compliance with the Dept. of Agriculture and/or local governing authority codes. Customer will be liable for any damages resulting from such action including but not limited to Company’s cost to re-install or re-locate the tank so that all code requirements are met. Company has the right to suspend deliveries until the equipment meets all code requirements or remove its equipment if Customer refuses to comply.

3. MAINTENANCE: Company will have the right at all reasonable times to enter Customer’s property to install, repair, service, remove, move, disconnect, or inspect the tank(s) and equipment furnished by Company. Customer shall not attempt to install, repair, service, remove, move, disconnect, or in any manner tamper with any and all equipment provided by Company.

4. DELIVERY: Company will have the right at all reasonable times to enter Customer’s property to deliver propane. For reasons including but not limited to changes in customer usage, appliance changes in the home, system changes, actions of suppliers, acts of God, and/ or weather conditions, Company does not and cannot guarantee that Customer’s tank(s) will never run empty regardless of Customer delivery type (will call or autofill.) While Company will make every reasonable effort to deliver propane to Customer, Company will not be responsible for any damages resulting from tank being out of propane. Customer should periodically check the tank gauge percentage and notify company if level is low.

5. SAFETY: Customer agrees to operate equipment in a safe and lawful manner. Company will not be liable for any damages or injuries incurred due to negligence or misuse by Customer or any third party. By signing below Customer acknowledges receipt and understanding of the propane safety information provided.

6. DAMAGES/SERVICE INTERRUPTION: Company is not liable for damages or injuries resulting from acts of God or any other circumstances beyond Company’s control including, but not limited to, flooding, hurricanes, tornadoes, lightning, wind, and heavy snow or ice. In the event of inclement weather, Company will make every effort to deliver to Customer; however, Company may suspend delivery if roads or weather conditions place employee(s) or property at risk.

7. SERVICEABILITY: Customer acknowledges that a safe driveway or delivery area is available. Company is not responsible for damages resulting from improper foundations or from normal wear and tear related to weather and/or age of driveway or entrance area.  Customer further agrees to keep driveway clear and passable from debris, snow, ice, or other impairments. Delivery service may be suspended if driveway is not passable.  

8. ASSIGNMENT: Customer agrees to notify Company in the event the property is sold. This agreement will terminate upon the sale of the property and cannot be assigned or assumed by the new property owner. If the property is sold, the propane in the tank remains the property of Company and cannot be conveyed to Buyer if Seller has not paid for the propane in tank.

9. PAYMENT TERMS: Company agrees to provide propane service to Customer as long as Customer pays account in accordance with company terms.  Payments are due in full within thirty (30) days of the invoice date for customers with approved credit.  Finance charges will be assessed at a rate of 1.5% per month on any past due balance.  Any and all other payment arrangements must be approved by Company.  Customer shall be liable for all charges related to returned checks or bank drafts as provided in G.S. 6-21-3 and G.S. 25-3-506. Customer shall additionally be liable for any fees or charges incurred from a collection agency and/or reasonable attorney’s fees and court costs in the event debt collection is required. Company reserves the right to remove equipment, adjust or disconnect its equipment, and/ or suspend delivery upon Customer’s failure to comply with payment terms. Company agrees to notify Customer prior to removing equipment.

10. CANCELLATION: This agreement will remain in effect for one (1) year and continue thereafter unless terminated by either party by giving ten (10) days notice.  If customer requests termination, Customer agrees to pay Company’s costs to remove its equipment (see Item 12 - TANK REMOVAL).

11. TANK LEASE/USAGE REQUIREMENT: Company has provided tank(s) for the purpose of delivering propane to Customer. A 100 gallon capacity tank will be assessed a tank rental (plus tax) that is billed annually regardless of propane gallons used annually.   If minimal or no propane has been delivered within a twelve month period, Company reserves the right to implement fees and/or delivery or rental charges on tanks with a 200 gallon or greater tank capacity.

12. TANK REMOVAL: If tank(s) need to be removed for any reason including but not limited to non-payment or if Customer no longer uses propane, Company has the right to remove the tank(s) and any other Company owned equipment from the property. Customer agrees to pay Company’s costs to remove its equipment. Customer also agrees to pay a re-stocking fee per gallon of an amount set by Company if more than 5% remains in tank when it is removed from the property. These amounts would be deducted prior to Customer receiving reimbursement for any credit balance remaining on account. Note: for UNDERGROUND TANK(S) – In addition to Customer being responsible for the cost of tank removal, Customer will also be responsible for any and all reparations to the yard or landscaping.

13. PROGRAMS AND FEES: Company reserves the right to make changes, add, and/ or discontinue any and all existing programs, plans, services, charges, or fees at its discretion without prior notice.

• Important Propane Safety Information

I have read and understand Blue Ridge Energy's LP Gas Agreement and Propane Safety Information above. Additionally, by checking this box, I understand that I am electronically signing and accepting the terms of the LP Gas Agreement.