Delivery Schedule Request

Date:

Account Number:

Email Address:

I request a gas delivery be made every days for the tank that supplies my at the following address:

I understand that if the tank is more than 40% full upon your arrival for delivery, I will be subject to a delivery charge (currently $90) which will be billed to my account.

It is my request that this delivery schedule apply from to of each year unless changed or cancelled in writing.

I am aware of the need to frequently check the gauge(s) on the propane tank(s) located on my property to avoid an "all out" situation. IF I RUN OUT OF PROPANE FOR ANY REASON, NEW ENGLAND PROPANE WILL NOT BE RESPONSIBLE FOR ANY CONSEQUENTIAL DAMAGES I MAY INCUR, INCLUDING WITHOUT LIMITATION, FROZEN PIPES OR DAMAGE TO BUILDINGS AND THEIR CONTENTS.

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Signature:

Date: