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Thank you for choosing Blue Star Gas as your propane provider.
Your account will be set up with automatic credit card authorization for all propane purchases.
We appreciate you completing this application and look forward to serving you.
Customer Information
Company Name
*
Owners Name
*
Billing Address
*
City
*
State
*
Arizona
California
Oregon
Utah
Washington
Zip
*
Phone
Email Address
*
Contact
*
Ownership
*
Individual/Sole Proprietor
Partnership
Corporation
LLC
Other
Other
Propane Usage
*
Forklift
Food Truck
Construction
Outdoor Heating
Other
Other
Credit Card Information
Name on Card
*
Credit Card Type
*
Visa
MasterCard
Discover
American Express
Credit Card Number
*
Expiration Date (mm/yy)
*
Security Code
Location Information
Please choose your local Blue Star Gas office.
*
Coast Co.
Eugene Co.
Garberville Co.
McMinnville Co.
Medford Co.
Mt. Shasta Co.
Phoenix Co.
Redding Co.
Salem Co.
Santa Rosa Co.
Salt Lake City Co.
Seattle Co.
If you encounter problems with this form, please
email the Marketing Department
.