Appliance Update Form Appliance Update Form Customer form to complete when adding appliances to their account. Name First Last Email Customer Number Address 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 fireplaces-please read and check the shared responsibility statement at the end of this form. Thank youPropane Space Heater Yes Number of space heaters-please read and check the shared responsibility statement at the end of this form. Thank youPropane Hot Water Heater Yes Number of hot water heaters-please read and check the shared responsibility statement at the end of this form. Thank youPropane Cook Stove Yes Number of cook stoves-please read and check the shared responsibility statement at the end of this form. Thank youPropane Grill (connected to main propane supply, not a BBQ tank) Yes Number of grills-please read and check the shared responsibility statement at the end of this form. Thank youPropane Firepit (outdoor use) Yes Number of firepits-please read and check the shared responsibility statement at the end of this form. Thank youPropane Pool Heater Yes Number of pool heaters-please read and check the shared responsibility statement at the end of this form. Thank youPropane Generator Yes Number of generators -please read and check the shared responsibility 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 shared responsibility statement below regarding the following propane appliances: Fireplace, Space Heater, Hot Water Heater, Cook Stove, Grill, Firepit, Pool Heater, Generator. I understand that I have a ‘shared responsibility’ with Proulx regarding my appliance. 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 the above listed appliances 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. I have checked off that I have a GENERATOR and will notify Proulx when I lose power and my usage has increased. If usage of the above listed appliances has resulted in running out of propane, I may be subject to emergency delivery fees as a result of not sharing the responsibility in monitoring my tank level. Checking this box does not sign me up for automatic deliveries if I am not already on automatic delivery. CAPTCHA