Appliance Update Form Appliance Update Form Customer form to complete when adding appliances to their account. Name First Last Email Customer NumberAddress Street City StateAlabamaAlaskaAmerican 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 Oil Boiler Yes Number of oil boilersOil Furnace Yes Number of oil furnacesPropane Boiler Yes Number of boilersPropane Furnace Yes Number of furnacesPropane Fireplace Yes Number of fireplacesPropane Space Heater Yes Number of space heatersPropane Hot Water Heater Yes Number of hot water heatersPropane Cook Stove Yes Number of cook stovesPropane Grill (connected to main propane supply, not a BBQ tank) Yes Number of grillsPropane Firepit (outdoor use) Yes Number of firepitsPropane Pool Heater Yes Number of pool heaters-please read and check the statement at the end of this form. Thank youPropane Generator Yes Number of generators -please read and check the statement at the end of this form. Thank youSize of generator (kilowatts)Other propane appliances (not listed above)Please read and check your understanding of the statement below regarding Propane Generator/and or Propane Pool Heater: I understand that due to the varied usage of my pool heater and/or generator, Proulx is requesting my assistance in monitoring my tank level when sudden changes occur. If I am already on automatic delivery at this time, I understand that there are special circumstances due to the nature of the use of pool heaters and/or generators and their unpredictability. I agree that I will help to monitor my tank level and inform Proulx when I notice the tank is 20% or below. If I have checked off that I have a GENERATOR, I agree to notify Proulx as quickly as possible anytime when I lose power as running on a generator would cause my usage to drastically increase. If I have checked off that I have a POOL HEATER, I agree to notify Proulx as quickly as possible when I turn on my pool heater for the season, or when any drastic changes to the use of the pool heater will occur (such as heating it for a short bursts of time after long periods of non-usage, using it for increased periods of time above normal use, or for increased usage related to special events/gatherings). I am aware that if an undisclosed increase in usage of my generator and/or pool heater has resulted in running out of propane, I may be subject to emergency delivery fees, as determined on a case-by-case basis. Checking this box does not sign me up for automatic deliveries if I am not already on automatic delivery. CAPTCHA