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Class 1 - Dealer License

  1. Include DBA

  2. Provide information for the primary contact person for the license.

  3. If any information is not known enter "not known" in the space provided.

  4. List all branches operating in Kansas

  5. List all manager and employees involved with propane

    Upload list if necessary

  6. List all cylinder delivery trucks operating in Kansas and license tag numbers

  7. List all storage facilities, tanks and WC

    Do not include dispenser tanks

  8. List all Dispensers (pump connected to container)

  9. Check the Following Services you will Perform in Kansas

  10. Read and initial the following.

  11. By typing my name and date below, I certify that this information is true and correct. Any false or fraudulent statement or failure to comply with the rules and regulations promulgated by the Office of the State Fire Marshal or K.S.A. 55-1812 shall be cause for suspension or revocation of the license held.

  12. Leave This Blank:

  13. This field is not part of the form submission.