Iowa: 1674 Green Bay Road, Wever, IA 52658 | Wisconsin: 621 Copenhagen Lane, Denmark, WI 54208

Progas LP & Supply, Inc. Customer Application

New residential customers must have an application on file. Please fill out, confirm and submit. We will call to verify and gather additional information once we receive your application. Thank you for choosing Progas LP & Supply, Inc.
* Required information
1 - Application Information  
(all applicants must complete)
  Your Name (f / m / l):
*
  Address:
*
  City:
*
  State / Zip:
*
  Email Address:
*
  Home Phone:
*
() 
  Cell Phone:
*
() 
 
Rent Own Other     more 
  Mortgage Lender / Landlord:
*
  Lender / Landlord Phone:
*
   
Employment:
  
  Your Employer:
*
  Employer Address:
*
  Employer City:
*
  Employer State / Zip:
*
  Employer Phone:
*
( )  
Credit References:
  
  Bank Account:
*
  Complete Address:
*
  Phone w/Extension:
*
  Contact:
*
  Creditor Name :
*
  Complete Address:
*
  Phone w/Extension:
*
  Contact:
*
Personal References:
  
  Relative Name (not living with you):
*
  Address:
*
  City:
*
  State / Zip:
  Phone:
*
  Relationship:
*
2 - Co-Applicant Information, if for a Joint Account
Go to Step 3 if there is no co-applicant for this application (go) 
  Name (f / m / l):
*
  Address:
*
  City:
*
  State / Zip:
*
   
  Email Address:
*
  Home Phone:
*
( )  
  Cell Phone:
*
( )  
Employment:
  
  Employer:
*
  Employer Address:
*
  Employer City:
*
  Employer State / Zip:
*
  Employer Phone:
*
()  
Credit References:
  
  Bank Account:
*
  Complete Address:
*
  Phone w/Extension:
*
  Contact:
*
  Creditor Name:
*
  Complete Address:
*
  Phone w/Extension:
*
  Contact:
*
Personal References:
  
  Relative Name (not living with you):
*
  Address:
*
  City:
*
  State / Zip:
  Phone:
*
  Relationship:
*
3 - Account Information
I want to be on WILL-CALL.
Only deliver propane to me when I have made a request. I will call to request a propane delivery before my tank reaches 20%.
Extra fees may apply.
I want to be placed on a routed delivery schedule.
Progas will deliver propane to my tank when they are in the area.
4 - Propane Tank Information
Please enter any additional information here:
Previous Propane Supplier
Current Tank Percentage: The current fill-level of my propane tank: %
I use propane for the following (please check all that apply):
Furnace
Stove
Water Heater
Fireplace
Clothes Dryer
Garage
Agriculture
other
5 - Confirmation and Submit
I confirm that the information set forth above is complete and accurate. I authorize Progas LP & Supply, Inc. to substantiate and investigate the application.
  Confirm: (Type 'YES' to confirm) *
 more 
  Your Name:
*
 
 
Questions? Please call 1-800-728-2285


  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Progas LP & Supply, Inc. 1-800-728-2285 | Web site by Propane Resources, LLC