Stop Delivery Request

Date:

To:

Customer Service Department
New England/Greenwich Propane
162 Grassy Plain Street
Bethel, CT 06801

Account:

Name:

E-Mail Address:

Address:

City:

State:

Zip:

I am requesting that New England / Greenwich Propane hold my future deliveries as follows:

Start Date of holding deliveries:

Resume automatic deliveries:

By signing this form I acknowledge and agree to accept all risks and damages that could possibly result from not having my tank adequately filled. These risks specifically include an underground tank floating out of the ground, which is prone to happen when the ground is wet. I am aware that in order to prevent an underground tank from floating, New England Propane suggests that the tank be maintained at a minimum of 40% full.

Print Name:

Signature:

Date: