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Pict
                 
    STRAIGHT PATH SERVICE STATION         
    185 ROUTE 109           
    WEST BABYLON, NY 11704          
    PHONE: 631-321-0549   FAX: 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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