24-Hour Emergency Propane Service: (563) 357-0816

RIVER VALLEY COOPERATIVE

Address: 3478A Hwy 927, Durant, IA 52747

Phone 800.730.2838 | www.rivervalleycoop.com | Fax 563.785.4627

24-HOUR EMERGENCY PROPANE SERVICE: (563) 357-0816

Propane Order Form

NOTE: This order form is for current, chargeable River Valley Cooperative propane customers only.

Please fill out the following information. Save and email completed form to . IMPORTANT: All information on order form must be completed. Incomplete order forms will not be accepted.

ENERGY ACCOUNT NAME: Click here to enter text.

PHYSICAL DELIVERY ADDRESS: Click here to enter text. (street address, city, state)

TANK DESCRIPTION: (Example: Home, Shop, etc.) Click here to enter text.

CURRENT DAYTIME PHONE #: Click here to enter text.

CURRENT TANK PERCENTAGE: Click here to enter text.

GALLONS REQUESTED: 250 Gallons or Fill? Click here to enter text.

ADDITIONAL NOTES: Click here to enter text.

DELIVERY POLICIES:

250-gallon minimum delivery.

72-hour delivery notice. To avoid additional fees, call in at 25% or above.

A leak test must be performed on any tank 5% or under.

DELIVERY FEES:

Delivery Fees for Out of Gas: (If 10% or less one of these fees may apply, if 5% or less one of these will be assessed)

Will Call Labor Rates: Same Day Same Day After Hours Weekend/Holiday

(Includes Leak Test) (Includes Leak Test) (Includes Leak Test)

Out of Gas 1st $125.00 per trip $225.00 per trip $275.00 per trip

Out of Gas 2nd $175.00 per trip $275.00 per trip $325.00 per trip

Out of Gas 3rd $225.00 per trip $325.00 per trip $375.00 per trip

A letter will be mailed out after 3rd out of gas in a 12-month period stating we will discontinue service.

Delivery Fees for Non-Out of Gas:

After Hours Delivery $100.00 per trip

Weekend/Holiday $200.00 per trip

Low Percent Del. W/O 72-Hour Notice $ 65.00 per trip

Trip Fee for Non-Delivery $ 65.00 per trip

Phone 800.730.2838 | www.rivervalleycoop.com | Fax 563.785.4627