JACKMAN’S OF BRISTOL INC. 64 JACKMAN DR. BRISTOL, VT 05443
   

NEW CUSTOMER INFORMATION SHEET

*** FOR BUSINESS ACCOUNTS ONLY ***

MUST HAVE BOTH HOME OWNERS NAMES ON ACCOUNT
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Applicant #1 Applicant #2

** JACKMAN’S OF BRISTOL POLICY REQUIRES A CREDIT CARD TO BE KEPT ON FILE TO BE CHARGED AFTER EACH TRANSACTION OR MONTHLY. PLEASE CALL THE OFFICE WITH CC INFO. **

** IF TENANT **
Previous Fuel Supplier

*ALL LP/PROPANE DELIVERIES ARE SET UP AS AUTOMATIC DELIVERY. *

AS OF December 14, 2017
NEW JACKMAN’S OF BRISTOL, INC. POLICY FOR ALL PROPANE CUSTOMERS


JACKMAN’S OF BRISTOL, INC. new policy for all propane customers new and old, will be automatic deliveries whether you are a regular, prebuy, budget, or C.O.D. customer.

Automatic delivery will make timely deliveries and eliminate the majority of the run outs. This will benefit you the customer as well as us the company.

If you are a C.O.D. customer you will be required to keep a credit card on file to be charged before the ticket leaves the building, the minimum charge of what the Attorney General considers minimum deliveries for your size tank as follows:

TANK SIZE                                                           MINIMUM DELIVERY
23.6 GALLONS (SINGLE 100LBER)                     23.6 GALLONS MINIMUM
47.2 GALLONS (2 100 LB TANKS)                       47.2 GALLONS MINIMUM
100 GALLONS (Q TANK 120 LB)                          96 GALLONS MINIMUM
250 GALLONS ( HORIZONTAL TANK)              125 GALLONS MINIMUM
330 GALLONS (HORIZONTAL TANK)               175 GALLONS MINIMUM
500 GALLONS (HORIZONTAL TANK)               225 GALLONS MINIMUM
1000 GALLONS (HORIZONTAL TANK)             300 GALLONS MINIMUM

You also could keep money on your account using cash, or check, but when the ticket comes out the money needs to be available.

If your delivery takes less than charged you will have a credit on your account toward the next delivery or if it takes more your credit card will be charged the balance due.

Timothy Bouvier

 

PLEASE READ CAREFULLY AND SIGN BELOW YOUR TYPED NAME ON THIS FORM REPRESENTS YOUR SIGNATURE Applicant(s) consents to abide by the payment policies. Payment policies are: 1.) If you pay within 10 days of delivery you may deduct $.10 PER GALLON 2.) If you pay after the 10 days you are to pay the TOTAL of the delivery ticket or invoice 3.) All service is expected to be paid upon receipt of the Jackman's Inc. invoice 4.) Monthly statements are sent out at the end of each month 5.) Account balances unpaid over 30 days will be charged a service charge of 1 1/2% per month which is compounded monthly. In case of failure to pay within 90 days, the applicant will be charged expenses incurred in collecting the outstanding balance including ATTORNEY FEES and COLLECTION COSTS.
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PROPANE DEALER’S DISCLOSURE OF CHARGES

NEW LP GAS CUSTOMERS PLEASE SIGN AND SUBMIT WITH YOUR APPLICATION

Dated: April 1, 2026

CHARGE AMOUNT VALID UNTIL
*New Customer Tank Set Time and Materials April 1, 2027
Security Deposit 30% Estimated Annual Bill April 1, 2027
Permit/Inspection Charge $150.00 per hour April 1, 2027
Equipment Installation Charge plus Materials charge Per Sales Proposal April 1, 2027
Service Diagnostic Fee $150.00 per hour April 1, 2027
Leak or pressure test charge plus materials $150.00 per hour April 1, 2027
After-hours delivery charge $150.00 flat rate April 1, 2027
Meter Read Fee $ April 1, 2027
Equipment Lease Fee $ April 1, 2027
Tank Monitor $25/year April 1, 2027
Special Trip Charge $150 per hour April 1, 2027
Minimum Annual Purchase $ April 1, 2027
Late Payment Fee 18.5% A.P.R. April 1, 2027
Equipment Reconnection Charge $150.00 per hour April 1, 2027
Early Service Termination Fee $150.00 per hour April 1, 2027
Pump Out/restocking Charge $150.00 per hour April 1, 2027
Equipment Removal Charge $150.00 per hour April 1, 2027
Return Check Fee $25.00 April 1, 2027
**Tank Pickup if less than 1 year Time and Materials April 1, 2027
Minimum Delivery Gallons Per CF 111.08 250 G tank - 125 G min
325 G tank - 175 G min
500 G tnak - 225 G min
1000 G tank - 300 G min		 April 1, 2027
State of Vermont S.5 Fee
Minimum Delivery Gallons:		   April 1, 2027
Per CF 111.08
250 gallon tank – 125 gallon minimum
325 gallon tank - 175 gallon minimum
500 gallon tank - 225 gallon minimum
1000 gallon tank -300 gallon minimum		    
Tank Pick up fee if less than 1 Year
Time and Material
April 1, 2027



This offer will remain in effect for 12 months from the date of this Disclosure, April 1, 2026. You may be required to sign a written agreement and/or complete a credit check that is satisfactory to the dealer. This Disclosure is in addition to the terms and conditions of any agreement between the dealer and you. Advice on buying propane gas is available on the web-site of the Vermont Attorney General’s Consumer Assistance Program, www.uvm.edu/consumer (click on “Propane Advice”).

If the word “variable” appears, it means that the amount of the charge may increase at any time. If no amount or date is stated, the charge or lack of charge will remain in effect for one year from the date of this Disclosure (or three years for charges relating to termination of service).

This Disclosure form is written in accordance with the Attorney General’s CP-111: Revised: April 1, 2026
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IN ORDER TO RECEIVE LP GAS SERVICE, THIS FORM MUST BE SIGNED AND DATED AND RETURNED WITHIN 7 DAYS OF RECEIPT.
 

Thank you for choosing Jackman’s of Bristol! We appreciate you!

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