Company Information

Max Credit Applied For $

Name of Firm

Phone Number

Mailing Address

Delivery Address

Federal ID

Business Type

Fax Number

Email

Years Established

Is business incorporated?
No Yes

Are you tax exempt from propane purchases? (if so, please enclose tax exemption form)
No Yes

Name and address of Officers or Owners of Firm

Who is authorized to charge on this account?

Are purchase orders required to charge your account?
No Yes

Bank Information

Name

Account Number

Address

Contact

Phone Number

Fax Number

Trade Credit references (Suppliers)

First

Contact

Phone Number

Fax Number

Second

Contact

Phone Number

Fax Number

Third

Contact

Phone Number

Fax Number

How did you hear about us?

Note: The applicant agrees to all credit terms on the reverse side of this application. In consideration of Global Energy extending credit, the undersigned who is financially interested in the above paying firm, hereby unconditionally guarantees to Global Energy the payment of all sums due Global Energy by the above firm. You are authorized to check my credit references now and periodically as needed, and to answer questions about your credit experience with me. Enclosure of current financial statement will expedite our processing of your application.

I/WE AGREE TO CREDIT TERMS LISTED ON REVERSE (Please return original. Make a copy for your records).