Summer Fill 2024

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Date *

Account Number

Name *

First

Last

Address *

City *

Contact Number *

Email *

Please list which propane tank(s) you would like filled for the Summer program:

Tank 1 *

Size of tank

Tank 2

Size of tank

Tank 3

Size of tank

Tank 4

Size of tank

Tank 5

Size of tank

The above-named customer agrees to participate in Tri-Energy Cooperative's 2024 Summer deferred program and understands propane will be delivered between June 1st, 2024, and August 31st, 2024. Payment will be due by September 25th, 2024, to avoid any additional fees.

Signature *

Please e-sign agreement by typing your name.