You must have JavaScript enabled to use this form. Personal Information Applicant Name * Home Address * Mailing Address * City / Town Province - None -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Residence * Rent Own Email * Telephone * Fax Date of Birth Employer How Long Employed? Do You Have Federal & Provincial Tax Exemption? * Yes No Tax Exemption Details Federal Tax Exemption Federal Tax Exemption Federal Tax Exemption Type Number Item weight Add more items more items Provincial Tax Exemption Provincial Tax Exemption Provincial Tax Exemption Type Number Item weight Add more items more items Bank Reference Do You Have A Bank Reference? * Yes No Bank Information Bank Name Branch # / Account # Bank Telephone City / Town Contact Name Payment Options * CanGas Propane offers many payment options to our customers. Please indicate your preference. Cheque ? Cash ? Online and Telephone Banking ? Pre-Authorized Payment ? Credit card (MasterCard and Visa) ? Debit / Interac ? Budget Payment Plan ? Credit References Do you want to apply for credit? * Yes No Credit References Form Please provide two credit references. Credit Reference 1 Company / Name Contact Address Telephone Fax Email Credit Reference 2 Company / Name Contact Address Telephone Fax Email Credit Agreement CREDIT APPLICATION AND OPERATING AGREEMENTI authorize CanGas Propane Partnership to make investigations of my credit standing for which this application is made, as deemed to be necessary by CanGas. Upon approval of this application for a credit account, the signature(s) on this application are deemed to constitute acceptance of the Credit Operating Agreement below.CREDIT OPERATING AGREEMENTIt is agreed between the parties to this agreement as of the date first herein written that CanGas Propane Partnership will sell and deliver up Propane Partnership products, as agreed to by the personal applicant herein mentioned. The applicant agrees to pay, in accordance with CanGas published credit terms, all charges including but not limited to, service or late payment charges, delivery and pickup charges, permit and inspection fees and charges. In the event the applicant’s account is in arrears, any future purchases will be declined until the account is cleared. Balance due is payable upon receipt. For accounts past due over 30 days interest charged will be 24% per annum. Service Information CanGas Propane Location ? * Select a LocationCastlegar, BCClairmont, AB Fort St John, BCGolden/Invermere, BCKamloops, BCKindersley, SKPeace River, ABProvost, ABRedcliff, ABSaskatoon, SKShaunavon, SKSlave Lake, ABSwift Current, SKValemount, BCWainwright, AB Delivery Locations & Directions ? Is CanGas Tank Already in Place from Previous Owner? * Yes No Tank Size Requested 420lb (Pig Tank) 500 Gallon Tank 1000 Gallon Tank I'm unsure of what tank size I need Account Settings CanGas Propane has the ability to send your invoices and monthly statement via email or mail. Please indicate how you would like to receive your documents. Invoices * Mail Email Monthly Statement * Mail Email How Would You Like to be Contacted? * Telephone Email Email Phone Consent Signature * Sign above Type Your Name * Terms and Conditions I agree to all * Your data will be used to perform the service you require. Your data will be used to process your request.
You must have JavaScript enabled to use this form. Personal Information Applicant Name * Home Address * Mailing Address * City / Town Province - None -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Residence * Rent Own Email * Telephone * Fax Date of Birth Employer How Long Employed? Do You Have Federal & Provincial Tax Exemption? * Yes No Tax Exemption Details Federal Tax Exemption Federal Tax Exemption Federal Tax Exemption Type Number Item weight Add more items more items Provincial Tax Exemption Provincial Tax Exemption Provincial Tax Exemption Type Number Item weight Add more items more items Bank Reference Do You Have A Bank Reference? * Yes No Bank Information Bank Name Branch # / Account # Bank Telephone City / Town Contact Name Payment Options * CanGas Propane offers many payment options to our customers. Please indicate your preference. Cheque ? Cash ? Online and Telephone Banking ? Pre-Authorized Payment ? Credit card (MasterCard and Visa) ? Debit / Interac ? Budget Payment Plan ? Credit References Do you want to apply for credit? * Yes No Credit References Form Please provide two credit references. Credit Reference 1 Company / Name Contact Address Telephone Fax Email Credit Reference 2 Company / Name Contact Address Telephone Fax Email Credit Agreement CREDIT APPLICATION AND OPERATING AGREEMENTI authorize CanGas Propane Partnership to make investigations of my credit standing for which this application is made, as deemed to be necessary by CanGas. Upon approval of this application for a credit account, the signature(s) on this application are deemed to constitute acceptance of the Credit Operating Agreement below.CREDIT OPERATING AGREEMENTIt is agreed between the parties to this agreement as of the date first herein written that CanGas Propane Partnership will sell and deliver up Propane Partnership products, as agreed to by the personal applicant herein mentioned. The applicant agrees to pay, in accordance with CanGas published credit terms, all charges including but not limited to, service or late payment charges, delivery and pickup charges, permit and inspection fees and charges. In the event the applicant’s account is in arrears, any future purchases will be declined until the account is cleared. Balance due is payable upon receipt. For accounts past due over 30 days interest charged will be 24% per annum. Service Information CanGas Propane Location ? * Select a LocationCastlegar, BCClairmont, AB Fort St John, BCGolden/Invermere, BCKamloops, BCKindersley, SKPeace River, ABProvost, ABRedcliff, ABSaskatoon, SKShaunavon, SKSlave Lake, ABSwift Current, SKValemount, BCWainwright, AB Delivery Locations & Directions ? Is CanGas Tank Already in Place from Previous Owner? * Yes No Tank Size Requested 420lb (Pig Tank) 500 Gallon Tank 1000 Gallon Tank I'm unsure of what tank size I need Account Settings CanGas Propane has the ability to send your invoices and monthly statement via email or mail. Please indicate how you would like to receive your documents. Invoices * Mail Email Monthly Statement * Mail Email How Would You Like to be Contacted? * Telephone Email Email Phone Consent Signature * Sign above Type Your Name * Terms and Conditions I agree to all * Your data will be used to perform the service you require. Your data will be used to process your request.
