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Milton Propane’s Business Application/Credit Check for Service


Equipment/Service Information
Do you currently have tank/equipment on site? Own or Lease Tank size Current %
Underground? Current Supplier:
Business Information
Business Name: Years Open: Temp Or Perm
Main Business Contact Name: Title:
Business Address: Phone Number:
PO Box: City: State: Zip:
Delivery Address (Where propane deliveries will be made) Delivery City: Delivery State: Delivery Zip:
Special Delivery Instructions
Contact Information
Billing Address (Invoices & Statements will be mailed here): Billing City: Billing State: Billing Zip:
Accounts Payable Contact: Accounts Payable Phone Number:
Email Address: Fax Number:
Is account tax exempt?
Trade References, need to be completed for temporary sites and businesses open 1 year or less
1.) Trade Reference: Account No.: Years with:
Contact Name: Contact Email:
2.) Trade Reference: Account No.: Years with:
Contact Name: Contact Email:
3.) Trade Reference: Account No.: Years with:
Contact Name: Contact Email:




SUBMIT by clicking your nearest Service Center listed below.


Thank you for choosing Milton Propane
  
Milton
Sayner
Rochelle
Kaukauna
Waupun
Sturgeon Bay
(800) 822-8046
(877) 445-3292
(866) 562-5999
(800) 747-1060
(800) 320-0375
(888) 909-4888