Residential Credit Application

Fill out and SUBMIT or Print and send to doyle@legacypropanellc.com

Your Name:*

SSN#:*

Your Address:*

City,State,Zip:*

Home Phone:*

Work Phone:*

Employer Name:*

How Long?:*

Employer Address:*

City,State,Zip:*

Spouse's Name:

SSN#:

Spouse's Employer:

How Long?:

Employer Address:

City,State,Zip:

Own/Rent:

House/Mobile/Other:

Closest Relative:

Relative Phone:

This information must be provided to open an account with Legacy Propane LLC. The information provided will be used only for credit evaluation purposes. Legacy Propane LLC credit terms are as follows: A $.10 discount per gallon will be given if payment for fuel is received within 10 days of delivery date. Net payment is due within 30 days of delivery date. Service Charges are computed at a rate of 1.5% per month or 18% per year on balances over 30 days. I hereby agree that in the event of default in the payment of any amount due, and if this account is placed in the hands of a collection agency or attorney for collection or legal action, to pay an additional charge equal to the cost of collection including collection agency and attorney fees and court costs incurred.