Credit Application

Date / Time

Date

Time

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

BUSINESS USE

Name/ Position/ SS#

Partnerships

Name/ SS#

F.E.I.N. #

PERSONAL USE

Name

First

Last

Social Security Number

Employed By

Position / How Long?

Name of Spouse

How Long at Present Location?

Real Estate

Home

Farm

Other

CREDIT REFERENCES

Name/Address/City/Telephone Number

BANK REFERENCES

1. Bank Name / Bank Officer / Account #

2. Bank Name / Bank Officer / Account #

TERMS

Net amount of invoices due and payable in full upon receipt of bi-monthly statement. In the event the above named customer defaults in its payment as required hereunder, customer agrees to pay all costs of collection, including reasonable attorney’s fees and court costs. A finance charge of one and three quarters percent (1¾%) per month or twenty-one percent (21) per annum or fifty cents ( $.50 ) minimum per month will be charged to the customer on all amounts not timely paid as specified herein. It is agreed that all charges to this account will be paid in accordance with above described terms.

Signature

By typing your signature, you agree to the terms.

The following guarantee is required for all corporate accounts: The undersigned, individually, agrees to irrevocably guarantee all obligations incurred by the above named corporation to Parish Oil Co., Inc. under this credit agreement and agrees to be bound by all the terms set forty herein.

Signature

By typing your signature, you agree to the terms.

Credit application