Bainonline Creditapps

Tankwagon Credit Application

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Company Name*

Mailing Address*

City*

State*

Zip*

Delivery Location*

Delivery City*

Delivery State*

Billing Contact*

Billing Email*

Billing Phone*

Billing Fax

On-Site Contact*

On-Site Phone*

On-Site Fax

Federal Tax ID*

Is a Purchase Order required?*

Y
N

Diesel Above Ground Tank Size

Diesel Under Ground Tank Size

Kerosene Above Ground Tank Size

Kerosene Under Ground Tank Size

Is this a permanent tank location?*

Y
N

If not, how long will the tank be at this location?

Does any equipment need to be filled?*

Y
N

If so, please list the number and types of equipment

Direction or Special Instructions

Bain Oil Co. does not charge a delivery fee during normal business hours. However, a 50-gallon minimum charge will apply. Applicant(s) consents to a credit check based upon the information provided on this application for the purpose of extending credit. It is further understood and agreed by Applicant(s) that if credit is extended to Applicant(s), the terms of such credit account will be Net 30 days. Applicant(s) agrees to pay a finance charge of 1½% per month which shall be added to any account not paid in full by due date. In the event of any default, Applicant(s) agrees to pay all costs of collection including reasonable attorney’s fees if incurred.

Applicant agrees to Application Terms*

Applicant's Name*

Applicant's Title*

Application Date*

Notes (internal use)