Customer Agreement – Pirate Propane

Please fill out our new customer application form below. For tank requests, please fill out the form here.

We also have a fleet of tanks available for purchase. Please call our office for more information.

Account Name
Mailing Address
Street Address Address Line 2 City State ZIP Code
Physical Address
Street Address Address Line 2 City State ZIP Code
Cell Phone
Home Phone
Work Phone
Appliances Served
Do you own or rent your home?
- Own
- Rent
Landlord's Name
Landlord's Phone
Tank Info.
If there is current propane tanks on the property not included in this lease, please list them below.
Tank Size
Make
Serial Number
Year
Tank Size
Make
Serial Number
Year
Tank Size
Make
Serial Number
Year
Do you need to lease a tank?*
- Yes
- No
Lease Terms
The person named below enters into a legally binding lease agreement with Pirate Propane, Inc for the lease of a propane tank. The propane tank rent shall be the amount entered below per year for the following propane tank(s).
Your Name*
Amount*
Review and sign credit terms and lease agreement.
CREDIT TERMS: Charges are due upon delivery. Any charges not paid by the 1st of the following month after delivery was made, will be subject to Finance Charges of 1.5% per month or 18% per annum. Failure to pay charges and/or Finance Charges may result in discontinuance in service and referral to collections. Customer agrees to pay all reasonable costs of collection, including attorneys fees and court costs. Budget plans may be available, but must be arranged prior to delivery of propane. Customers on budget payment plans are required to make monthly payments with an annual "true-up" payment to settle any remaining balance on their account.

TANK LEASE AGREEMENT: Customer agrees to provide access to Pirate Propane, Inc. to install, service and remove propane tank. Customer agrees to pay tank lease on an annual basis. Tank lease is non refundable and non transferable. Customer agrees that leased tank will not receive deliveries or repairs by anyone other than Pirate Propane, Inc., or its agents. If at any time:
- The tank is not in active use
- Service is stopped for non payment
- Terms of this agreement are violated
Pirate Propane, Inc. shall have the right to enter the customers property and remove the lease tank at any time. Customer will be credited for any propane remaining in the tank, less a 20% handling fee. Credit will be assessed at the sale price of the last delivery or current market price, whichever is highest. A $250.00 removal fee will be due at the time of pickup, or the customer may purchase the propane tank for Pirate Propanes current selling price. Customer must apply with all applicable regulations, standards and codes. Combustible materials, such as wood piles, building materials, other fuels and oils, etc. shall not be stored within 10 feet of the tank. Structures and sources of ignition shall be distanced from the tank as required by the LP gas code. The Customer shall notify Pirate Propane, Inc. should any repairs to appliances or the customers domicile be made or new appliances added to the system.

I/We agree to the CREDIT TERMS and/or TANK LEASE AGREEMENT explained above.
Signed*
Date*
MM slash DD slash YYYY
Spouse/Other
Date
MM slash DD slash YYYY
Credit Terms
CREDIT TERMS:Charges are due upon delivery. Any charges not paid by the 1st of the following month after delivery was made, will be subject to Finance Charges of 1.5% per month or 18% per annum. Failure to pay charges and/or Finance Charges may result in discontinuance in service and referral to collections. Customer agrees to pay all reasonable costs of collection, including attorneys fees and court costs. Budget plans may be available, but must be arranged prior to delivery of propane. Customers on budget payment plans are required to make monthly payments with an annual "true-up" payment to settle any remaining balance on their account.

PURCHASE AGREEMENT:Customer must apply with all applicable regulations, standards and codes. Combustible materials, such as wood piles, building materials, other fuels and oils, etc. shall not be stored within 10 feet of the tank. Structures and sources of ignition shall be distanced from the tank as required by the LP gas code. The Customer shall notify Pirate Propane, Inc. should any repairs to appliances or the customers domicile be made or new appliances added to the system. By signing this agreement, customer claims that the serviceable propane tank is privately owned and not leased from another company.

I/We agree to the CREDIT TERMS and/or PURCHASE AGREEMENT explained above.
Signature
Date
MM slash DD slash YYYY
Spouse/Other
Date
MM slash DD slash YYYY

Tank Info.

Lease Terms

Credit Terms