Secured Form
Company Details
  1. (Required)
  2. (Required)
  3. (Required)
  4. (Valid Email Required)
Billing Contact Details
  1. (Required)
  2. (Required)
  3. (Required)
Delivery Contact Details
Pricing Contact Details
  1. (Valid Email Required)
Route Contact Details
  1. (Valid Email Required)
AP Contact Details
  1. (Valid Email Required)
Safety Contact Details
  1. (Valid Email Required)
Tank Contact Details
  1. (Valid Email Required)
Purchasing
  1. Are purchase order (PO) numbers required?
  2. Request Monthly Statements?
  3. Which contact should we send statements to?
  4. Requested payment type
  5. Is your purchase from TJP sales tax exempt?
Local Credit References
  1. Please attach a document containing your references or you can fax your reference information to 626-338-4194
Principal, Owners, or Officers Information
  1. (Required)
  2. (Required)
  3. (Required)
  4. (Required)
  5. (Required)
  6. (Required)
  7. (Required)
  8. (Required)
Propane Service
  1. (Required)
  2. Type of service(s) needed
  3. (Required)
  4. TERMS: Invoices are 10 DAYS NET. Customer agrees to remit payment within 30 days or be subject to COD service. Any outstanding balance is subject to a finance charge at the highest allowable rate by law. I agree to pay all court costs, attorney fees, and/or collection fees for the unpaid balance. I hereby under the penalty of perjury, certify that I am an active company principle and assume full personal responsibility for the debts incurred by the applying company. I hereby release the above named entities’ credit information, and authorize Ted Johnson Propane Co. and its’ agents to check our company’s credit history.
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