New Customer Form

Submitted by mwbyrd on Tue, 2009-09-01 11:39

This is the form for new customers to fill out.

Contact Information

Date:

First Name:

Last Name:

Phone Number #1:

Phone Number #2:

Street Address:

City:

State:

Zip:

Email Address:

Delivery Options

Please Select Yes or No:

	Yes	No
Auto Fill: (Requires an approved charge account) This is a delivery service where we periodically check your tank and fill as needed. Special Delivery and Cash Accounts: With this account you are fully responsible for monitoring your fuel needs and ordering on a timely basis

Regulator Agreement

Please select Agree or Disagree:

	Agree	Disagree
All propane gas systems must utilize an "integral two stage" or "split regulator" system. If your tank has the older "single state" regulator, it must be changed before we can service your stystem
Duty to Warn: I was given written safety guildelines for using propane.

Out of Gas Agreement

Please Select Agree or Disagree:

	Agree	Disagree
If you run out of gas, state law requires that we must test our entire system before your gas service can be reactivated. This means that you or a responsible person MUST BE HOME AT THE TIME OF YOUR DELIVERY, AND THERE WILL BE A SERVICE CHARGE FOR THE TST AND REACTIVATION.

Customer Duty to Notify

Please Select Agree or Disagree:

	Agree	Disagree
Customer is required by Louisiana stature to notify Cordill Propane within five days or prior to delivery of gas of any changes or additions to their gas system or appliacnes.

Appliances

Appliances (Please list your gas appliances):

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Contact Us

Please contact us with any questions at one of our locations.!
Winnsboro, LA 318 435-6190
Monroe, LA 318 324-8884

TV Commercial

Cordill Propane recently produced a TV commercial for local TV. View our TV Commercial and learn more about Cordill Propane and our history. Click to View

About Propane - Characteristics, Properties and Combustion

Propane is a liquefied petroleum gas that comes out of both oil and gas wells. Propane does not occur naturally though. Raw crude oil or raw natural gas is refined to make different types of petroleum products, one of which is propane. Following it's refinement, propane is stored as a liquid under pressure until utilized, at which point it becomes a gas. for! Learn More

Primary links

New Customer Information