Company Name::

Company Address (Street, City, State, Zip)::

Primary Contact::

Title::

Office Phone::

Cell Phone: :

Email::

Website::

Section 2 – Fueling Contact & Services Contact for Scheduling Fueling Contact Name (if different from above)::

Fueling Contact Email::

Fueling Services Please check all that apply:
We welcome propane school buses during normal business hours.
After-hours fueling is available by appointment.
Emergency fueling is available (when possible).
We can accommodate full-size school buses.
Our fueling location has adequate turning radius and bus access.

Hours of Operation Monday - Friday (Please Indicate if Hours are Different on Different Days::

Preferred advance notice before fueling (if any)::

Fueling Location Information Fueling Station Name (if different from company)::

Street Address (City, State, Zip)::

GPS or Google Maps Address (if different)::

Fueling Details Do you currently fuel propane-powered school buses?:
Yes
No

If No, do you anticipate offering this service in the future?:
Yes
No

If school buses are fueled at another location, please provide that information (Company Location and Address):

Fueling Method:
Dispensing Pump
Fast-Fill System
Both
Other

Additional Services & Amenities::
Can accommodate multiple school buses at one time
Easy access for buses (wide entrance/turning radius)
Convenient access from a major highway
Driver restroom available
Waiting area available
Overnight parking available in emergency situations
Accepts school purchase orders
Accepts fleet fuel cards
Can provide fueling outside normal business hours by appointment
Emergency contact available after hours

Other services or accommodations::

Additional Notes Please provide any information that would help transportation directors plan their visit (gate codes, access instructions, seasonal hours, notice requirements, etc.).:

The Kentucky Propane Fueling Station Cooperative Directory is provided to participating Kentucky school districts to assist them in locating propane fueling stations while traveling throughout the Commonwealth. Please indicate your authorization below:
I authorize KYPERC to publish the company and fueling location information provided on this form in the Fueling Station Cooperative Directory.
I authorize KYPERC to include my listing in printed directories, electronic directories, and future online mapping tools for participating districts
Please contact me before publishing any future updates or changes to my listing.

I understand that participation in the Kentucky Propane Fueling Station Cooperative is voluntary and provided at no cost. I understand that KYPERC serves only as the administrator of the Fueling Station Cooperative Directory and does not establish fuel pricing, purchase propane, coordinate fueling schedules, guarantee service availability, or participate in fuel transactions. I understand that all pricing, billing, scheduling, and fueling arrangements are solely between my company and the participating school district. I certify that the information provided on this form is accurate to the best of my knowledge and agree to notify KYPERC if my company information, contacts, or fueling location details change. (Name, Title, Date)::

Additional Notes::

Submit