            |
|
CREDIT APPLICATION Taylor Oil Co., Inc. Salesman:_____________________ Approved By:___________________ (PLEASE TYPE OR PRINT NEATLY) I. BUSINESS INFORMATION Amount of Credit Applied For: _______________________ Business Name: __________________________________________________________________ Telephone #: ____________________ Business Address: ____________________________ Zip: __________ Fax #: _____________ ____________________________ Type of Business: ____________________ Billing Address (if different): _________________________________________________________ Country:______________________ Employer I.D. #: ______________ In business since: ________ [ ] Incorporated [ ] Partnership [ ] Sole Proprietorship DUNS #: ________________ Date of Incorporation: ________________ State of Incorporation:__________ --------------------------------------------------------------------------------------------------------------------------------- Full Name of Principles/Corporate Officers Position Residence Address 1.________________________________________________________________________________ Social Security Number: _________ - ______ - _________ Home Phone:__________________ 2.________________________________________________________________________________ Social Security Number: _________ - ______ - _________ Home Phone:__________________ If any of the principles have been with the firm less than 3 years; provide name, location and position with previous business: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Is the applicant involved in any pending litigation? ____________
_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Has the company been involved with a bankruptcy or insolvency proceedings in the past seven (7) years? _____________ If so, set forth all details concerning these proceedings: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ List any other name or names under which the applicant transacts business: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ II. JOB SITE INFORMATION Job Site Location:_________________________________________________________________ Do you do bonded jobs? [ ] Yes [ ] No Bonding Company:________________________ Bonding Company Address:________________________ Phone #: ______________________ Contact Person:_________________________________ Are you subject to the following taxes: State Sales Tax [ ] Yes [ ] No State Diesel Tax [ ] Yes [ ] No Federal Diesel Tax [ ] Yes [ ] No Franchise Tax [ ] Yes [ ] No If NOT taxable you must furnish EXEMPTION FORMS Price Quoted: ITM _____________________________ Tank_____________________________ III. BUSINESS REFERENCES 1.______________________________________________________________________________ Address: _______________________________________________________________________ Phone:__________________________________ Fax:___________________________________ Doing business with since: _______________ High Credit: ___________________ Any NSF checks:__________________ 2.______________________________________________________________________________ Address: _______________________________________________________________________ Phone:__________________________________ Fax:___________________________________ Doing business with since: _______________ High Credit: ___________________ Any NSF checks:__________________ 3.______________________________________________________________________________ Address: _______________________________________________________________________ Phone:__________________________________ Fax:___________________________________ Doing business with since: _______________ High Credit: ___________________ Any NSF checks:__________________ BANK: ( institution where account has been active for at least six months ) Bank Name: ___________________________________________________________________ Address:________________________________________________________________________ Type of Account: _________________________________________ Account Number:_________________________________________ Any NFS checks in the last six months? _____________ If so, how many: ________________ Any stop payments in the last six months? ____________ If so, how many:_______________ Have there been any executions upon your account in the last year? _____________________ Officer or Contact Name:_________________________________________________________ Phone #:________________________________ Fax #:_______________________________ V. BILLING INFORMATION Who to contact with billing questions:______________________________________________ Phone Number: ________________________________ Will a Purchase Order be used: [ ] Yes [ ] No Will you be paying by individual invoice or by statement?_____________________________ THE ABOVE SECTIONS MUST BE COMPLETED IN THEIR ENTIRETY TO PROCESS YOUR APPLICATION TERMS: Net amounts due in TWENTY(20) days. Default occurs on the TWENTY FIRST (21) day. A finance charge of one and one half percent (1.50%) per month will be assessed on any and all amounts past due. In the event of default requiring collection, the applicant agrees to pay, in addition to the delinquent amount and finance charges thereon, collection and/or attorney fees equal to twenty five percent (25%) of the delinquent amount. A service charge of $35.00 will be assessed for each check received which is returned unpaid for any reason. All deliveries below seventy-five gallons (75) will be assessed a thirty five dollar ($35.00) minimum gallon delivery charge. Upon each annual anniversary date of this agreement, Taylor Oil Company and their subsidiaries reserves the right to automatically increase the prices then in effect by the amount of the increase in the Consumer Price Index for the previous twelve months or five percent (5%) whichever is greater. I HAVE READ, UNDERSTAND, AND ACCEPT THE ABOVE TERMS AND HAVE PROVIDED TRUE INFORMATION. I FURTHER AUTHORIZED TAYLOR OIL COMPANY TO VERIFY ANY AND ALL REFERENCES, INCLUDING BANK ACCOUNT INFORMATION, TO DETERMINE OUR CREDIT CAPABILITIES AND TO REQUEST INFORMATION FROM CREDIT REPORTING AGENCIES. APPLICANTS NAME: _______________________________________________________________ BY: ______________________________ _______________________ __________________ PERSONAL GUARANTEE: I/WE INDIVIDUALLY, JOINTLY AND SEVERALLY PERSONALLY GUARANTEE PAYMENT OF ALL INDEBTEDNESS INCURRED FOR MERCHANDISE AND SERVICES FURNISHED BY TAYLOR OIL COMPANY INCLUDING FINANCE CHARGES AND COLLECTION OR ATTORNEYS FEES EQUAL TO 25% OF THE DELINQUENT AMOUNT. IT IS UNDERSTOOD THAT THIS GUARANTEE SHALL BE A CONTINUING GUARANTEE. I/WE DO HEREBY WAIVE NOTICE AND CONSENT TO ANY MODIFICATION OR RENEWAL OF THE CREDIT AGREEMENT HEREBY GUARANTEED. Individual: ______________________________________ (Signature) Social Security Number: __________ - ______ - __________ Date:_____________________ Individual: ______________________________________ (Signature) Social Security Number: __________ - ______ - __________ Date:_____________________ NOTE: The above statement MUST be signed to be accepted for processing. |