Residential Credit Application

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

If you are applying for an individual account in your own name and are relying on your income or assets and not the income or assets of another person as the basis for repayment of credit requested, complete only Section A. If you are applying for a joint account or an account that you and another person will use, complete all sections, providing information in section B about the joint applicant.

I'm applying for a/an(Required)

Individual Account

Joint Account

Section A - INFORMATION REGARDING APPLICANT

Name(Required)

First Last

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Mailing Address (If Different)

Street Address Address Line 2 City State ZIP Code

Time at Current Address(Required)

Rent or Own?(Required)

Rent

Own

Former Address (If Applicable)

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

Time at Former Address (If Applicable)

Employment

Current Employer

Supervisor

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

How Long Have You Worked There?

Position

Average Weekly Pay

Previous Employer

Supervisor

Address

Street Address Address Line 2 City State ZIP Code

Phone

How Long Did You Work There?

Position

Average Weekly Pay

Mortgage or Rent

Name of Mortgage Holder or Landlord

Address

Street Address Address Line 2 City State ZIP Code

Value

Current Balance

Monthly Payments

Banking References

Checking Account Bank Name

Branch

Savings Account Bank Name

Branch

Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Alimony, child support, separate maintenance received under:

Court Order

Written Agreement

Oral Understanding

Other Income $

Source(s) of Other Income

Is any income likely to be reduced in the next 2 years?

Yes

No

Please Explain

Section B - INFORMATION REGARDING JOINT APPLICANT

Name

First Last

Date of Birth

Email

Address

Street Address Address Line 2 City State ZIP Code

Phone

Mailing Address (If DIfferent)

Street Address Address Line 2 City State ZIP Code

Time at Current Address

Rent or Own?

Rent

Own

Former Address

Street Address Address Line 2 City State ZIP Code

Time at Former Address

Employment

Current Employer

Current Supervisor

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

How Long Have You Worked There?

Position

Average Weekly Pay

Previous Employer

Previous Supervisor

First Last

Address

Street Address Address Line 2 City State ZIP Code

Untitled

Phone

How Long Did You Work There?

Position

Average Weekly Pay

THE FEDERAL CREDIT EQUAL OPPORTUNITY ACT PROHIBITS CREDIT APPLICANT WITH RESPECT TO ANY ASPECT OF A CREDIT TRANSACTION ON THE BASIS OF RACE, COLOR, RELIGION, NATIONAL ORIGIN, SEX, MARITAL STATUS OR AGE. EVERYTHING I HAVE STATED IN THIS APPLICATION IS CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT POWERS OIL COMPANY WILL RETAIN THIS APPLICATION WHETHER OR NOT IT IS APPROVED. YOU ARE AUTHORIZED TO CHECK MY CREDIT AND EMPLOYMENT HISTORY AND TO ANSWER QUESTIONS ABOUT YOUR CREDIT EXPERIENCE WITH ME.

Applicant's Signature(Required)

Joint Applicant's Signature

CREDIT AGREEMENT MONTHLY STATEMENT: If you have a balance due on your account, we will send you a monthly statement. This statement will show separately your current month’s activity, including any FINANCE CHARGES, and the date that payment is due. FINANCE CHARGES: Payment in full is due within 30 days of the date of the invoice. If your bill is paid in full within these 30 days, you will not incur a finance charge. Any unpaid balance remaining after 30 days will incur a FINANCE CHARGE at the rate of 1.5% per month or 18% per year. The FINANCE CHARGE will be calculated based upon the unpaid balance of your bill. CREDIT FOR PAYMENTS: All payments will be credited the same day they are received. REVOCATION: Credit may be revoked at any time because of any late payment or default by you or because of any other event which causes Powers Oil Company, in good faith, to deem itself insecure or to believe that the prospect of your performance of any provision of this Agreement is impaired. COLLECTIONS: It is understood that for any credit we may extend to you if payment is not received when due and the matter may be turned over to an attorney or certified collections agency for collection, you will be responsible for all reasonable fees incurred plus all court costs and expenses. KEEP THIS NOTICE FOR FUTURE USE. THIS NOTICE CONTAINS IMPORTANT INFORMATION ABOUT YOUR RIGHTS AND OUR RESPONSIBILITIES UNDER THE FAIR CREDIT BILLING ACT. NOTIFY US IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL If you think your bill is wrong, or if you need more information about a transaction on your bill, write us as soon as possible on a separate sheet at the address below. We must hear from you no later than 60 days after we sent you the first bill on which the error or problem appeared. You may telephone us, but doing so will not preserve your rights. In your letter, give us the following information: • Your name and account number. • The dollar amount of the suspected error. • Describe the error and explain, if you can, why you believe there is an error. If you need more information, describe the item you are not sure about. Your Rights and Our Responsibilities After We Receive Your Written Notice We must acknowledge your letter within 30 days, unless we have corrected the error by then. Within 90 days we must either correct the error or explain why we believe the bill was correct. After we receive your letter, we cannot try to collect any amount you question or report you as delinquent. We can continue to bill you for the amount you question, including finance charges, and we can apply any unpaid amount against your credit limit. You do not have to pay any questioned amount which we are investigating, but you are still obligated to pay the parts of your bill that are not in question. If we find that we made a mistake on your bill, you will not have to pay any finance charges related to any questioned amount. If we didn't make a mistake, you may have to pay finance charges, and you will have to make up any missed payments on the questioned amount. In either case, we will send you a statement of the amount you owe and the date that it is due. If you fail to pay the amount that we think you owe, we may report you as delinquent. However, if our explanation does not satisfy you and you write to us within 10 days telling us that you still refuse to pay, we must tell anyone we report you to that you have a question about your bill. And, we must tell you the name of anyone we reported you to. We must tell anyone we report you to that the matter has been settled between us when it finally is. If we don't follow these rules, we can't collect the first $50 of the questioned amount, even if your bill was correct. SEND CORRESPONDENCE TO: Powers Oil Company 1681 West Main St. Alliance, Ohio 44601

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