Holtzman Propane Customer Referral Form
1. Please provide us with your account information. This will enable us to credit the correct account should your referral choose Holtzman Propane.
Name on Account:
*
Billing Address:
(Street or P.O. Box)
*
City:
*
State:
*
Zip Code:
*
Name on Account:
*
Delivery Address:
(Street # Only)
* If not the same as above
City:
* If not the same as above
State:
Zip Code:
* If not the same as above
Home Phone:
*
E-mail Address:
Work Phone:
*
Account Number:
2. Please provide us the name, address, and phone number of your referral.
Name of Referral:
*
Referral's Mailing Address:
*
City:
*
State:
*
Zip Code:
*
Referral's Daytime Phone:
Referral's Evening Phone:
*
3. Please describe your referral.
Neighbor
Relative
Co-Worker
Other
Currently Use Propane
For:
Heating
Hot Water
Gas Logs
Cooking
Generator
Other
4. Upon submission, we will contact your referral. We will also mail information to your referral about our services. Please allow us 3 business days to contact your referral.
5. If your referral chooses to switch to Holtzman Propane or become a new customer we will apply a credit of $25.00 towards your next purchase after your referral has received and paid for their first fill. This process may take approximately 30 - 60 days depending upon when they receive their first fill and payment is posted.
6. If your referral is not interested in our services or chooses not to switch to Holtzman Propane we will notify you by mail.