Tri-Gas Distributing Company

of Traverse City, MI

Propane Service Order Form


Tri-Gas Propane Order Form


Please fill out this form and submit query to order propane 

First Name:     

Last Name:  


Daytime Phone#: 


Home Phone#: 




Delivery Location: 
Address:  


City:  


State:  ZIP:  


Billing Address:


Address:  


City:  
State:  ZIP:  


E-mail Address:  


Method of Payment:


Credit Card:  # on File: 


No Number on File (will call Tri-Gas): 
(231) 946-9011



Visa: 


MC: 


Expiration Date:  
Inhouse Acct:  #:  
COD: 


Services Required


*100# Cylinder  Quantity  
*Bulk Tank Fill Existing%  
*Bulk Tank Gallons Requested  
*Delivery Date Requested  ASAP 


Comments:



  

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