Ownership Document Form Masons Propane Ownership Document Form You have requested our propane delivery services and we require proof of ownership for insurance purposes. If you do not have a copy of the original bill of sale for your tanks, fill out the ownership document form below. For our terms and conditions or safety pamphlet visit the website at https://www.masonspropane.com/ and click on the documents tab. If you have any questions or concerns please feel to contact us at (717)259-0624 and follow the prompts for service. I own the propane tank(s) listed at the below address and the tank(s) are considered my property. This statement was requested by Mason’s Propane Service LLC as well as a copy of my current driver’s license per Mason's liability insurance carrier. I understand that Mason’s is not liable if the tank is owned, locked off, or otherwise compromised, or held by false pretenses by another propane company.Name(Required) First Last Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Shipping Address My Shipping Address Is The Same As My Billing Address Shipping Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Add an Authorized User? I would like to add an authorized user to my account Name First Last PhoneEmail Tank Quanity(Required)(How many tanks)Tank Serial Number(s)(Required)If serial number is unknown please type "unknown"Tank Size(s)(Required)Tank location at propertyBehind the red shed on the right side of the drivewayTank Type(Required) Above Ground Underground Other… (Select all that apply)Propane Uses(Required) Primary Heat Back-up Heat Hot Water Cooking Dryer Fireplace Log Heater Garage Heat Generator (Check all that apply)Current Tank %(Required)Delivery(Required) Will Call For Delivery Automatic Delivery (Will call for delivery must call in at a minimum of 30% during the heating season)Would you like to place a request for a propane delivery? Yes No How would you like your invoices sent to you?(Required) At the door Mailed (only if mailing address is different) Email Customer portal Auto Delivery Frequency Approx. every 5 weeks Bi-monthly Every 6 months Once a year Special request (please call or email req.) (This only applies to customers requesting automatic deliveries)Please provide us with a copy of your Drivers License or State Issued ID Drop files here or Select files Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 64 MB. Consent(Required) I agree to these termsBy signing this form, I acknowledge that all the information I have supplied is true and understand that I accept the responsibilities that have been noted on this document and agree to these terms and conditions. I also acknowledge that if any of my information should change at any time or I would like to change terms or terminate my service with Mason’s Propane Service, I must contact them at 717-259-0624 as soon as possible. This document must be submitted to an employee of Mason’s Propane Service LLC.Name(Required) First Last Date(Required) MM slash DD slash YYYY
