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*Required Fields |
APPLICATION
FOR CREDIT
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Customer
Code: |
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*Phone: |
(
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Fax: |
(
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Company: |
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| Address:
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| *City:
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| *State/Region:
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| Zip/Postal
Code: |
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If
company, Type of ownership: |
Corporation
Partnership
Individual |
Date
Established: |
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Federal
Identification Number: |
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NAME
OF OFFICERS OR OWNERS OF FIRM
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1. |
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Officer's
Name: |
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Title: |
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Home
Phone: |
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Social
Security Number: |
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2. |
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Officer's
Name: |
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Title: |
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Home
Phone: |
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Social
Security Number: |
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3. |
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Officer's
Name: |
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Title: |
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Home
Phone: |
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Social
Security Number: |
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ADDITIONAL
INFORMATION
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Are
purchase orders required to charge to this account? |
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Are
signatures required to charge to this account? |
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Have
you ever filed any type of bankruptcy? |
If
yes, give:
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Dollar
amount of credit desired monthly: |
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FINANCIAL
REFERENCES
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Bank
Name: |
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Phone: |
(
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| Address:
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| *City:
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| *State/Region:
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| Zip/Postal
Code: |
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Checking
Account Number: |
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Savings
Account Number: |
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BUSINESS
REFERENCES WHERE CHARGE ACCOUNTS OR CREDIT NOW EXTENDED
*Must
be completed or application can not be processed
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1. |
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Name: |
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Phone: |
(
)
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Fax: |
(
)
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| Address:
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| *City:
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| *State/Region:
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| Zip/Postal
Code: |
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Account
#: |
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Contact
Person: |
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2. |
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Name: |
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Phone: |
(
)
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Fax: |
(
)
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| Address:
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| *City:
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| *State/Region:
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| Zip/Postal
Code: |
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Account
#: |
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Contact
Person: |
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3. |
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Name: |
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Phone: |
(
)
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Fax: |
(
)
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| Address:
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| *City:
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| *State/Region:
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| Zip/Postal
Code: |
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Account
#: |
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Contact
Person: |
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4. |
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Name: |
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Phone: |
(
)
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Fax: |
(
)
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| Address:
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| *City:
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| *State/Region:
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| Zip/Postal
Code: |
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Account
#: |
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Contact
Person: |
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CREDIT
AGREEMENT
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I
certify that all information in this application for
credit is true and accurate to the best of my knowledge.
I agree to authorize Seay Oil COmpnay, Inc. to make
credit inquiries and release crdit information to other
suppliers or agencies who inquire about my account.
If
this acount is opened, I agree to pay all invoices in
full by the 10th day of each month following purchase
or sooner if the established credit limit is exceeded
prior to the date the invoice is ude, unless otherwise
approved by Seay Oil Company, Inc.'s credit department.
A service charge of 1-1/2% or minimum of $1.00 will
be generated on all past due balances that go beyond
Seay Oil Company, Inc.'s net terms of the 10th day of
each month.
I
understand that if this account becomes delinquent,
I agree to pay all court costs, filing fees and Attorney's
fees, of not less than 33-1/3% of the total sum, and
further agree that if legal proceedings take place,
as a resident in the State of Kentucky, I agree to be
brought to the appropriate court in Chirstian County,
Kentucky. If a resident in the State of Tennessee, I
agree to be brought to the appropriate court in Montgomery
County, Tennessee.
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I
agree to the above terms and conditions:
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Company
Name: |
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Applicant
Name (Electronic Signature): |
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Title: |
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PERSONAL
GUARANTY
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In
consideration of this agreement of Seay Oil Company,
Inc. to extend credit to the above named company, the
undersigned guarantees unconditionally unto Seay Oil
Company, Inc. and its successors in interest full payment
of all sums which are now due or which hereafter become
due by the above named company to Seay Oil Company,
Inc. The amount of the maximum aggregate liability of
the undersigned guarantor shall not exceed $
principal indebtedness plus interest accruing on the
guaranteed indebtedness, fees, charges, and costs of
collection, incuding reseaonable attorney fees. It is
further agreed the Seay Oil Company, Inc. may later
refuse credit and that such refusal shall not affect
this guarantee. The date on which this guarantee termnates
is
.
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I
agree to the above terms and conditions:
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Electronic
Signature: |
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Title: |
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| *E-Mail:
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| Comments
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