Cooksey Oil Co., Inc.

Credit Application for a Business Account

Business Contact Information

Company name:

Phone:

Fax:

E-mail:

Street Address:

City:

State:

ZIP Code:

Account Contact:

Billing  Address:

City:

State:

ZIP Code:

Bank references

Bank Name:

Bank Contact:

Bank address:

Phone:

City:

State:

ZIP Code:

TRADE references

Company Name:

Address:

City:

State:

ZIP Code:

Phone:

Fax:

E-mail:

Contact Person:

Company Name:

Address:

City:

State:

ZIP Code:

Phone:

Fax:

E-mail:

Contact Person:

Company Name:

Address:

City:

State:

ZIP Code:

Phone:

Fax:

E-mail:

Contact Person:

Agreement

Customer agrees by the extension of credit to the following terms:

All invoices are to be paid within 30 days from the date of the invoice. Customer agrees to a finance charge of 1.5% per month for all account balances not paid within the aforementioned terms. Customer also agrees to pay all fees & expenses associated with the collection of unpaid balances.

By submitting this application, you authorize Cooksey Oil Co., Inc. to make inquiries into the banking and business/trade references that you have supplied.

Please fax completed application to: 618-532-4182

Signatures

Name:

 

 

 

Title:

 

Date:

Name:

 

 

 

Title:

 

Date: