Become A New Customer

Please complete the credit application below.

 
Name *
Name
Address
Address
Work Phone
Work Phone
Home Phone
Home Phone
Do you own or rent?
AS PART OF THE APPLICATION PROCESS, BLUE FLAME MAY ACCESS YOUR PERSONAL CREDIT REPORT, AND OR YOUR BUSINESS CREDIT REPORT (IF APPLYING FOR BUSINESS CREDIT). BY AGREEING BELOW, YOU GIVE PERMISSION FOR BLUE FLAME TO ACCESS YOUR CREDIT REPORT FOR THE PURPOSE OF GRANTING AND MAINTAINING CREDIT WITH BLUE FLAME GAS. *