Credit App

Huron Smith Oil Credit Application & Agreement

Instructions: Please complete this form in full to establish a credit line with Huron Smith Oil. Attach all required documents. If you have questions, contact at +1 (662) 563 9786 or email: info@huronsmithoil.com.

1. Company Information

Legal Business Name *

DBA Name (if applicable)

Street Address *

City *

State *

Zip *

Phone Company *

Fax Number *

Email *

Separate email addresses with a comma.

Business Type (check one) *

Corporation

Partnership

Sole Proprietor

Personal

Farm

State of Incorporation *

Years in Business *

Has the entity filed bankruptcy in the last 7 years *

Yes

No

2. Business Ownership

Provide information for up to two principals/owners:

Owner/Principal 1

Name *

Social Security # *

Address *

City/State/Zip *

Phone *

Fax Number *

Email *

Owner/Principal 2 (if applicable)

Name

Social Security #

Address

City/State/Zip

Phone

Fax Number

Email

3. Financial Institution Information

Bank Name *

Contact Name *

Street Address *

City/State/Zip *

Phone *

Fax Number *

4. Credit References

Fuel Reference

Business Name *

Contact Name *

Phone *

Fax Number *

Address/City/State/Zip *

Business Reference #1

Business Name *

Contact Name *

Phone *

Fax Number *

Business Reference #2

Business Name

Contact Name

Phone

Fax Number

5. Authorization and Agreement

I authorize Huron Smith Oil Co. to verify credit and business information. I agree to NET 30 or NET 10 payment terms and accept liability for finance charges (1-2% monthly on past due) and collection costs.

Legal Business Name *

Signature (Owner/Officer) *

Title *

Printed Name *

Date *

6. Personal Guaranty (Corporations/Businesses Only)

The undersigned guarantees payment of all debts to Huron Smith Oil Co. This guaranty is continuing unless revoked in writing.

Buyer Name *

City/County/State *

Signature of Guarantor *

Printed Name *

Title *

Repeat for additional guarantors if necessary

7. Customer Information

Federal Tax ID *

State Tax ID *

Sales Tax Exemption # *

Certificate attached

The maximum file size is 50 MB, and only PDF or DOC formats are allowed.

If you uploaded the document, indicate "Yes". If no, please explain why or provide a URL. *

Require Purchase Order Number *

Yes

No

Billing Contact

Name/Title *

Address/City/State/Zip *

Phone *

Fax Number *

Email *

Main Location Contact

Name *

Phone *

Fax Number *

Email *

8. Product and Tank Information

Do you have USTs (Underground Storage Tanks)

Yes

No

UST Facility #

Number of USTs

Total Capacity (gallons)

Average Monthly Usage

Tank Ownership

Lease

Loan

Own

Product Types (check all that apply)

NL

PNL

Diesel

Non-Ethanol

Farm Diesel

Kerosine

Preferred Delivery Type

Drop

Pump Off

9. Electronic Funds Transfer (EFT) Authorization

Account Name

Bank Name/Branch

Bank Address

City/State/Zip

Phone/Fax

Name on Account (if different)

Routing # (ABA)

Bank Account #

Account Type

Checking

Savings

Signature And Authorization

Authorized Signer Name *

Title *

Date *

Voided check or bank confirmation letter attached *

Consent *

I agree to the Privacy Policy and Terms of Investment.

Submit