Comer Oil Credit Application

COMPANY NAME:

MAILING ADDRESS:

CITY:

SC:

ZIP:

BUSINESS TYPE:

YEARS IN BUSINESS:

FED. ID NUMBER:

*EMAIL FOR DRAFT NOTICES & INVOICES:

NAME(S) OF OWNER:

PH:

NAME(S) OF OWNER:

PH:

WHAT PRODUCTS DO YOU CURRENTLY PURCHASE?

HOW MANY GALLONS DO YOU ANTICIPATE PURCHASING MONTHLY?

DO YOU PAY SALES TAX?

Yes

IF NO, PLEASE SUBMIT THE APPROPRIATE STATE APPROVED CERTIFICATE. ACCORDING TO STATE LAW, WE ARE LIABLE TO CHARGE AND COLLECT ALL APPLICABLE TAXES UNLESS WE RECEIVE THE STATE APPROVED FORMS REQUIRED.

*DESIRED PAYMENT METHOD:

CREDIT CARD (PLEASE NOTE THERE IS A 4% FEE ADDED)

CHECK

ELECTRONIC FUNDS TRANSFER - EFT

NOTE: ALL CUSTOMERS ARE SET TO 30 DAY TERMS UNLESS OTHERWISE APPROVED

PLEASE PROVIDE 3 CREDIT REFERENCES:

COMPANY NAME:

ADDRESS:

CONTACT NAME:

EMAIL:

PHONE NUMBER:

COMPANY NAME:

ADDRESS:

CONTACT NAME:

EMAIL:

PHONE NUMBER:

COMPANY NAME:

ADDRESS:

CONTACT NAME:

EMAIL:

PHONE NUMBER: