Pickford
(906) 647-2420
Gwinn
(906) 250-3913
Newberry
(906) 293-6590
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Full Name
Primary phone
Email address
Mailing address
Service address
Secondary phone
Place of employment
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How did you hear about us?
Township:
Do you own or rent?
Own
Rent
Residency status:
Full Time Resident
Part Time Resident
Type of building:
Frame
Modular
Mobile Home
Building square footage:
Switch out from what company?
Tank Size:
Percentage of gas left in tank:
Type of account:
Will Call
Auto Fill
COD
Budget:
Yes
No
Estimated gallons used per year:
Which of your appliances run on propane?
Furnace
Water Heater
Range
Dryer
Fireplace
Please indicate if there are any other appliances that run on propane:
Do you burn wood?
Yes
No
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