RESIDENTIAL | AGRICULTURAL | COMMERCIAL | INDUSTRIAL

Propane is a multifaceted fuel that can be used for much more than home heating. Propane is widely used throughout New England in residential, commercial, agricultural, and industrial applications. As a less expensive alternative to electricity, propane in homes is used for cooking, home heat, pool heat, generators, hot water, clothes dryers, space heaters, outdoor grills, and fireplaces.

Uncas Gas offers every-day value for your propane dollar, because we deliver more than propane, with customer benefits such as:

Comprehensive Gas System Checks
Prompt Pay Discounts on every delivery
24/7 Accessibility
Above and Below Ground Tank Installations

and more!

CUSTOMER CREDIT APPLICATION & PROPANE ACCOUNT SETUP FORM

How did you hear about us? *

PRIMARY APPLICANT INFORMATION

Primary Applicant Name *

First

Last

Primary Applicant Current Address *

Address Line 1

City

State

Zip Code

How long at this address? *

How long at this address *

Primary Applicant Date of Birth *

Primary Applicant PREVIOUS Street Address, City, State, Zip (if less than 1 year at current address) *

Primary Applicant Email *

Primary Applicant Phone *

PRIMARY APPLICANT EMPLOYMENT

Primary Applicant Employer *

Primary Applicant Employer Phone *

Primary Applicant Position/Job Title *

Primary Applicant Length of Employment *

Length of employment *

Primary Applicant Employer Address *

Address Line 1

City

State

Zip Code

PRIMARY APPLICANT FINANCIAL REFERENCES

Bank - Name *

Landlord or Mortgage Company *

Utility Company - Name *

City/State *

Phone *

IMPORTANT NOTICE TO CUSTOMER *

By signing below, you agree to the following

1. The information supplied is accurate as of the date shown; 2. An investigation of all statements or other credit data herein and release of such information to DCC Propane, LLC or any of its subsidiaries, from any and all sources is authorized; 3. A release is granted to all parties from all liability for any damage that may result from furnishing information to you; 4. To recognize that your individual credit history may be a factor in the evaluation of this credit application; and, 5. Consent to and authorize the use of any external credit reporting information utilized by DCC Propane, LLC or any of its subsidiaries, from time to time as may be needed.

Date / Time *

Date

Time

CO-APPLICANT INFORMATION

All fields below are required to have a co-applicant on the account.

Co-Applicant Name

First

Last

Co-Applicant Employer

Co-Applicant Employer Phone

Co-Applicant Position/Job Title (copy)

Co-Applicant Length of Employment

Length of employment *

Co-Applicant Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

IMPORTANT NOTICE TO CUSTOMER - Co-Applicant

By signing below, you agree to the following

Co-Applicant Signature Date / Time

Date

Time

Depending on where you live in Windham or New London counties in Connecticut, and select parts of Eastern Tolland County, Western Rhode Island and the lower parts of Southern Worcester county, your account may be serviced by our sister company, Northeast Oil & Propane. Click on their logo below to go to their website.

Sunday	Closed
Monday	8:00 AM - 4:30 PM
Tuesday	8:00 AM - 4:30 PM
Wednesday	8:00 AM - 4:30 PM
Thursday	8:00 AM - 4:30 PM
Friday	8:00 AM - 4:30 PM
Saturday	Closed