Jackman's of Bristol, Inc.
64 JACKMAN DRIVE, Bristol, VT 05443
Phone: 802 453-2381 Ext. 21 or 22, Fax 802 453-4403
NEW CUSTOMER INFORMATION SHEET |
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BUSINESS APPLICANTS FILL OUT THE FOLLOWING
Personal applicants may skip to the next section |
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Home Owners - we must have both names on accounts |
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You must call us with your Social Security Number. Please call 453-2381 X 21, 22 or 24.
For security reasons we do not ask you to enter the number online. |
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You must call us with your Social Security Number. Please call 453-2381 X 21, 22 or 24.
For security reasons we do not ask you to enter the number online. |
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Previous address |
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Landlord - (If Tenant) |
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Previous Fuel Supplier |
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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
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PLEASE READ CAREFULLY AND SIGN BELOW
YOUR TYPED NAME ON THIS FORM REPRESENTS YOUR SIGNATURE
Applicant(s) consents to a CREDIT CHECK based on the information provided on this application form for the purposes of extending credit.
Applicants further agree 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: June 1, 2024
| CHARGE |
AMOUNT |
VALID UNTIL |
| *New Customer Tank Set |
Time and Materials |
June 1, 2025 |
| Security Deposit |
30% Estimated Annual Bill |
June 1, 2025 |
| Permit/Inspection Charge |
$150.00 per hour |
June 1, 2025 |
| Equipment Installation Charge plus Materials charge |
Per Sales Proposal |
June 1, 2025 |
| Service Diagnostic Fee |
$150.00 per hour |
June 1, 2025 |
| Leak or pressure test charge plus materials |
$150.00 per hour |
June 1, 2025 |
| After-hours delivery charge |
$150.00 flat rate |
June 1, 2025 |
| Meter Read Fee |
$ |
June 1, 2025 |
| Equipment Lease Fee |
$ |
June 1, 2025 |
| Tank Monitor |
$25/year |
June 1, 2025 |
| Special Trip Charge |
$150 per hour |
June 1, 2025 |
| Minimum Annual Purchase |
$ |
June 1, 2025 |
| Late Payment Fee |
18.5% A.P.R. |
June 1, 2025 |
| Equipment Reconnection Charge |
$150.00 per hour |
June 1, 2025 |
| Early Service Termination Fee |
$150.00 per hour |
June 1, 2025 |
| Pump Out/restocking Charge |
$150.00 per hour |
June 1, 2025 |
| Equipment Removal Charge |
$150.00 per hour |
June 1, 2025 |
| Return Check Fee |
$25.00 |
June 1, 2025 |
| **Tank Pickup if less than 1 year |
Time and Materials |
June 1, 2025 |
| 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 |
June 1, 2025 |
| Tank Pick up fee if less than 1 year |
Time and Material |
June 1, 2025 |
This offer will remain in effect for 12 months from the date of this Disclosure, June 1, 2024.
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 June 1, 2024 |
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