GASCO PROPANE CONSUMER CREDIT APPLICATION:

NAME:	_______________________________________________
DELIVERY ADDRESS:	_______________________________________________ _______________________________________________ _______________________________________________ COUNTY: ______________________________________
MAILING ADDRESS:	_______________________________________________ _______________________________________________ _______________________________________________
PRIMARY RESIDENCE:	YES: ____ NO: ____	RENTAL PROPERTY:	YES: ____ NO: ____
HOME PHONE:	_______________________	WORK PHONE:	_______________________
EMPLOYER:	_______________________________________________
EMPLOYER ADDRESS:	_______________________________________________ _______________________________________________ _______________________________________________
PREVIOUS PROPANE SUPPLIER:	_______________________________________________
SPECIAL INSTRUCTIONS, REQUIREMENTS, AND DELIVERY INSTRUCTIONS:	_______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________

All Rental Propane Tank accounts will be set up as Automatic Delivery accounts.

Please print and send completed form to:
GASCO PROPANE
PO Box 816
Three Lakes, Wl 54562

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