SMALL TRUCK DELIVERY CREDIT APPLICATION
Fields marked with an asterisk (*) are required.

 

 

 

 

 

 

*Company Name:     

*Mailing Address:      *City:      *State:       *Zip: 

*Delivery Location:      *City:      *State: 

*Billing Contact:       *Phone #:       Fax #: 

*E-mail Address: 

*On Site Contact:       *Phone #:       Fax #: 

*Fed. Tax ID #:       *Purchase Order Required?  Yes    No

 

DELIVERY INFORMATION
 

Directions / Special Instructions: 

 

 

 

 

*TANK SIZES

 

 

FUEL TYPE

ABOVE GROUND

UNDER GROUND

 

High-Sulfer Diesel (off road)

 

Kerosene (off road)

 

 

 

*Is this a permanent tank location?  Yes    No
*If not permanent:
          How long anticipated at this location? 

 

*Is there equipment that will need to be filled?  Yes    No
*If equipment will be filled:
          How many and please identify type(s) 

 

Bain Oil Co. does not charge a delivery fee during normal business hours.
However, a 50-gallon minimum charge will apply.

 

 

 

 

 

 

Terms of Application
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 1% 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.

 

 

 

 

 

 

  *I agree to the above terms.

*Name:       *Title:       *Date: 

 

For security purposes, please type in the submission code you see in the image below:

*

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PRODUCTS & SERVICES

  • Home Heating Oil and Kerosene
  • Gasoline and Diesel Delivery
  • Above Ground Fuel Oil Tank Installation
  • Commercial and Residential Deliveries
  • Natural Gas Systems, Oil Burners, Heat Pumps
  • Fuel for Emergency Generators at hospitals, nursing homes, manufacturing plants, computer labs, etc.

We also install and service heating and air conditioning systems through our Bain Heating and Bain Air Conditioning divisions.

SERVICE AREAS

  • Randolph County, Guilford County, Forsyth County, Davidson County, and areas of Rockingham County and Alamance County
  • Greensboro, High Point, Winston-Salem, Kernersville, Summerfield, Oak Ridge, Stokesdale, Colfax, Pleasant Garden, Reidsville, Browns Summit, Gibsonville, McLeansville, Whitsett, Julian, Jamestown and surrounding areas
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