CREDIT CARD INFORMATION

Credit Card Information

Name on KeeBee Account

Card Number

Cardholder's name as shown on card

Expiry Date

CVV#

Card Type

Full Address Associated with Credit Card

CREDIT APPLICATION (Mandatory_ By clicking the above box, you authorize KeeBee Propate to charge this, plus a 3% processing fee, in the event that your accont is in arrears for more than 2 weeks

AUTOPAY (Optional). By clicking the auto pay box, you authorize KeeBee Propane Ltd. to process all invoices on your account through this including a 3% processing fee.

By clicking this box, I am signing my name and I hereby agree to all off the stipulations in this form. I agree to keep all of my information current, should I not, I will be charged a $35 NSF Fee. This authorization will remain in full force and effect until KeeBee Propane Ltd. has received written notification from me of this documents termination in such time and in such manner as to afford KeeBee Propane Ltd. at least 30 days to process the request.

Submission Successful. Thank you!

Phone: 403.934.5193

KEEBEE

PROPANE

Credit Card Information