Commercial Credit Application

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This field is for validation purposes and should be left unchanged.

Company Name(Required)

DBA

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Same as Billing Address?

Yes

No

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Same Address as Payables Clerk?

Yes

No

Address of Payables Office

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Type of Business(Required)

Corporation

Limited Liability Corporation

Partnership

Sole Proprietorship

Date of Incorporation

State of Incorporation

Corporate ID Number

Exemptions:

Sales Tax

Federal Tax

Premises:(Required)

Own

Lease

Name(s) of Corporation Officers, Partners or Sole Proprietor

Name(Required)

First Last

Title

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

EIN Number

Name

First Last

Title

Home Address

Street Address Address Line 2 City State ZIP Code

Phone

EIN Number

Credit Line Requested ($)(Required)

Estimate of Monthly Fuel Requirements(Required)

Years of Financial Statements Attached (send via email: customercare@powersoilandpropane.com)(Required)

Banking References

Bank(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Account Officer(Required)

Phone(Required)

Bank

Address

Street Address Address Line 2 City State ZIP Code

Account Officer

Phone

Trade References

Name of Business(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Name of Contact(Required)

First Last

Name of Business

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name of Contact

First Last

ALL BILLS ARE DUE IN FULL WITHIN 30 DAYS FROM THE DATE OF INVOICE. A FINANCE CHARGE OF 1.5% PER MONTH OR 18% PER YEAR WILL BE CHARGED ANY BALANCE UNPAID AFTER 30 DAYS. THIS CREDIT APPLICATION IS SUBJECT TO THE APPROVAL OF, AND ANY CREDIT WILL BE EXTENDED BY, POWERS OIL COMPANY. I HAVE READ, UNDERSTAND AND ACCEPT THE ABOVE TERMS AND HAVE PROVIDED TRUE INFORMATION. I FURTHER AUTHORIZE POWERS OIL COMPANY TO VERIFY ANY AND ALL REFERENCES GIVEN TO DETERMINE OUR CREDIT CAPABILITIES AND TO REQUEST INFORMATION FROM CREDIT REPORTING AGENCIES. ON BEHALF OF THE COMPANY, I AGREE TO PAY FOR ALL AUTHORIZED PURCHASES MADE ON THE ACCOUNT.

Corporate or Partnership Name(Required)

Date(Required)

Signature(Required)

Name and Title

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