Open Account and Service Agreement

Please fill out this form to apply for an open account and agree to our terms and conditions. After submitting the form, we will contact you at our earliest convenience. Please make sure to read our terms and conditions. Alternatively, you may download a PDF form to submit via mail or in person.

Co-applicant Information

Co-applicant First Name

Co-applicant Middle Initial

Co-applicant Last Name

Co-applicant Home Phone Number

Co-applicant Work Phone Number

Co-applicant DOB

Co-applicant SSN / Tax ID

Co-applicant Street Address

Co-applicant City

Co-applicant Zip Code

Co-applicant County

Co-applicant Email Address

Applicant Information

Applicant First Name (required)

Applicant Middle Initial

Applicant Last Name (required)

Applicant Home Phone Number (required)

Applicant Work Phone Number

Applicant DOB (required)

Applicant SSN / Tax ID (required)

Applicant Street Address (required)

Applicant City (required)

Applicant Zip Code (required)

Applicant County (required)

Applicant Email Address

Delivery Information

Street Address (required)

City (required)

Zip Code (required)

County (required)

Do you own or rent your residence? (required)

Landlord Name

Landlord Phone Number

Landlord Address

Propane Usage

Current propane supplier (Only if switching to ProTech Energy, Inc.)

Propane usage

Do you own your own propane tank?
(If tank is not owned by customer, delivery terms must be Automatic.)

Terms

Oil Usage

Current oil supplier (Only if switching to ProTech Energy, Inc.)

Oil usage

Tank Location

Terms

Tax Number

Payment Information

Please choose which account type you are applying for.

Additional Information

Use this field if you would like to send along any
additional information or notes to ProTech Energy.

Please Read the Terms and Conditions

You may download this form for your records.

Notice to Buyer

  1. This agreement supersedes any previously existing agreement between ProTech Energy and Customer
  2. Do not sign this agreement if any blanks are left open or without first reading.
  3. Fees and finance charges are subject to change.

I (we) agree to be subject to the terms disclosed in the credit or purchase agreement when issued and any purchases will constitute my/our acceptance of those terms. We hereby certify that the information provided above and any attachments included herein are true and correct and are furnished for the purpose of requesting ProTech Energy to extend credit to the undersigned. Applicant(s) authorizes ProTech Energy to obtain a credit report in connection with this application and any update renewal, modification, collection or extension of the credit and authorizes ProTech Energy to report my/our performance under this agreement or any other agreement I may have entered into with ProTech Energy to any credit reporting agency and to answer any questions regarding my/our credit history with ProTech Energy. Upon Request, ProTech Energy will inform applicant of the name and address of any credit reporting agency which furnished a report.

A. Payment Date ProTech bills will be paid within 20 days of the invoice date to avoid a FINANCE CHARGE.

B. Default If I do not pay my OPEN ACCOUNT total due within the time specified:

  1. A FINANCE CHARGE: may be computed on the unpaid Average Daily Balance. I will pay a FINANCE CHARGE determined by multiplying the Average Daily Balance by the appropriate periodic rate of 1.33% per month (ANNUAL PERCENTAGE RATE 16%).
  2. A SHUT-OFF of my gas supply may occur.
  3. A SPECIAL TRIP CHARGE will be incurred for run-outs or turning my gas service back on. (automatic customers)
  4. A deposit or COD may be required. I further agree that if I do not abide by the terms and conditions of this agreement I:
  5. Waive any claim for loss, damage or injury which may result.
  6. Will pay reasonable legal fees and collection cost incurred by ProTech to retrieve its property or collect overdue payments.

C. Equipment I understand that the tanks (propane or diesel skid tanks), regulators, blocks and other special equipment are the property of ProTech and TITLE TO THAT EQUIPMENT remains with ProTech. While I am using that equipment I agree that:

  1. I will not tamper with or move this equipment.
  2. I will not allow anyone else to service, put gas in or use the equipment.
  3. I will notify ProTech when any appliances connected to this service are added, removed or replaced.
  4. ProTech has reasonable access to its equipment for service, maintenance or removal.

D. Delivery Provisions I understand that ProTech will make every attempt to maintain a dependable supply of propane and/or oil, however ProTech makes no warranties, nor assumes any liability for consequences if the system runs out of propane or oil.

  1. I agree to maintain access to the propane tanks and oil fill in such manner to avoid undue risk, damage or injury to ProTech employees and equipment. Driveways and areas around the tank must be clear of snow and obstacles for delivery to be made.
  2. I understand that if an off route delivery is made because I have not met the terms and conditions of this agreement, I will pay a special trip charge as per the fee schedule (available on request) in effect at the time of the off route delivery.

E. Returns and Refunds Upon termination of service covered by this agreement, ProTech will credit any gas remaining in the propane tank at the price at which it was paid, less a tank pump-out charge of 40 cents per gallon which will be deducted from the price of the gas being returned.
There is no charge for removal of an empty tank.

F. Term Service is terminable at will by either the customer or ProTech. Termination shall occur when ProTech removes its equipment from your premises and all balances owing are paid.

G. Dishonored Check If any check of the customer is dishonored, the customer shall pay the company a dishonored check fee of twenty-five ($25.00) dollars.

OIL

  • Automatic customers must be credit approved.
  • Automatic customers need to call if they would like summer deliveries stopped.
  • If automatic customers calls to request delivery before regular schedule and minimum of 150 gallons are not met a fee of $25.00 will occur.
  • Will Call accounts must pay at time of delivery.
  • Any customer receiving HEAP will become COD for non HEAP deliveries.
  • Will Call customers must give 3 business day notifications for delivery. If you must have a delivery before the three day time limit, an off route charge may apply. See fee schedule for prices.

PROPANE

  • All propane accounts must be automatic delivery (unless customer owns his/her tank).
  • If the propane tank is owned by the customer, see the “oil” section above.
  • A charge of $150 will be charged to you, the customer, if you terminate service before end of two (2) years to reimburse the company for the free tank set. If the customer switches suppliers after this two year period, there will be no charge for tank pick up. In consideration of ProTech Energy selling goods and services to me on open account, I hereby agree to the terms and conditions of this application for Open Account and Service Agreement.

Please read the above terms and conditions.

In consideration of ProTech Energy, hereinafter called ProTech, selling goods and services to me on open account, I hereby agree to the terms and conditions on this application for Open Account and Service Agreement.

By checking this box and clicking send, you are digitally accepting the terms and conditions and entering into an agreement with ProTech Energy.

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