TO SUBMIT THIS FORM YOU MUST CHECK "I AGREE": Even the best safeguards can be defeated under the right circumstances. Jack Griggs Inc. hosts this website with a North American web hosting company evaluated for safety and data center security; a first step in securing any website. The data is encrypted in transit through the SSL connection, and "encrypted at rest", meaning the database itself stores the submitted data in an encrypted format that requires a special digital key to unlock. Despite all these measures, nothing is 100% secure. You agree to hold Jack Griggs Inc harmless for any unintended loss of control over the information, and all subsequent effects, submitted through this form.

Description of property purchased under the certificate: Liquefied Petroleum Gas/LPG (Propane)

When you submit this form,the date stamp created by the system (along with various fields) creates a unique digital signature that is used in place of a physical signature.

The Applicant has delivered this application to Jack Griggs, Inc. as a request to extend credit to the Applicant. Everything that has been stated in this application is correct to the best of the undersigned’s knowledge. The Applicant understands that Jack Griggs Inc. will rely on the truth, accuracy, and completeness of this application. The Applicant certifies that the information supplied herein has been carefully read and is true, correct, and complete.

The undersigned hereby personally guarantees payment of all purchases of any and all products and services from JACK GRIGGS, INC.

The undersigned thereof, whether suit is instituted or not, the prevailing party shall be entitled to reasonable attorney’s fees and costs of litigation in such amount as may be determined by the Court having jurisdiction.

NOTICE: I/We hereby authorize Jack Griggs Inc. or any credit reporting agency employed by you to investigate the Applicants’ credit record, authorized to investigate my/our credit record, contact my/our credit references and any credit bureaus, and report to proper persons and bureaus my/our performance of this agreement, and to answer questions about Jack Griggs Inc. credit experience with me/us.

Guarantor agrees and acknowledges that JACK GRIGGS, INC., and the undersigned are entering into a purchasing agreement in reliance upon Guaranty being provided hereunder by Guarantor, and that this Guarantee is being to enter into this agreement.

ECOA Notice 701:
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applications on the basis of race, color, religion, national origin, sex, martial status, age (providing the applicant has the capacity to contract): because all or part of the applicants income derives from any public assistance program; or because the applicant has, in good faith, exercise any right under the consumer credit protection act. The Federal Agency what administers compliance with the law concerning the creditor is The Federal Trade Commission, Equal Credit Opportunity Act, Washington, D.C. 20580.

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