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    FUEL OIL/DIESEL CREDIT APPLICATION           
    185 ROUTE 109             
    WEST BABYLON, NY 11704            
   

PHONE: 631-321-0549   FAX: 631-321-4799

PRINT/FILL-OUT, FAX TO  631-321-4799

        
                   
                     
The undersigned company is applying for credit with OK Petroleum and agrees to abide by the standard terms and conditions of as printed on the second page.   
                   
COMPANY NAME                   
DBA (IF DIFFERENT)                   
CONTACT PERSON                  
ADDRESS                    
PHONE       FAX            
FEDERAL TAX ID OR SOCIAL SECURITY NUMBER            
TYPE OF BUSINESS       NUMBER OF EMPLOYEES      
DATE BUSINESS ESTABLISHED                
TYPE OF PRODUCTS YOU WILL PURCHASE            
AMOUNT OF CREDIT REQUESTING$              
                   
ARE YOU A:                   
                   
CORPORATION                  
                   
STATE OF INCORPORATION                
                   
NAME, TITLES, AND ADDRESSES OF YOUR THREE CHIEF CORPORATE OFFICERS      
                   
                     
                     
                     
                   
NAME AND ADDRESS OF THE RESIDENT AGENT            
                     
                   
PARTNERSHIP                  
                   
NAME AND ADDRESSES OF THE PARTNERS             
                     
                     
                     
                   
SOLE PROPRIETORSHIP                
                   
ARE YOU TAX EXEMPT?                
HAVE YOU EVER HAD CREDIT WITH US BEFORE?            
IF YES, UNDER WHAT NAME?                
                   
AUTHORIZED PURCHASERS                 
                     
                     
PURCHASE ORDER REQUIRED ?              
                   
                   
TRADE REFERENCES                  
                   
REFERENCE #1  NAME                
  ADDRESS                
  PHONE                
                   
REFERENCE #2 NAME                
  ADDRESS                
  PHONE                
                   
REFERENCE #3 NAME                
  ADDRESS                
  PHONE                
                   
BANK REFERENCE                  
                   
BANK #1    ACCOUNT#               
  PHONE                
  CONTACT PERSON            
  NAME OF BANK            
  ADDRESS                
                   
BANK #2   ACCOUNT#               
  PHONE                
  CONTACT PERSON            
  NAME OF BANK            
  ADDRESS                
                   
                   
I represent that the above information is true and is given to induce to extend credit to the applicant. My company and I authorize to make such credit investigation as sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to any and all information concerning the financial and credit history of my company and myself.   
 
                   
I have read the terms and conditions stated below and agree to all of these terms and conditions.     
                   
AUTHORIZED SIGNATURE:                
PRINTED NAME:                  
TITLE:         DATE:          
                   
GENERAL TERMS AND CONDITIONS AND PERSONAL GUARANTEE           
                   
Bills are sent on the first day of each month. All bills become payable in full on the 11th day of the month and if not paid by the end of the month are considered past due.  
                   
No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department.  
                   
PERSONAL GUARANTEE: If the credit consumer is a corporation, then those signing this application, whether signing as an officer or not, personally guarantee payment for all items purchased on credit by the corporation.   
 
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