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New Customer ApplicationAPPLICATION

Please complete and sign the form below to apply for a business account with RK Allen Oil. This information will be used to establish credit terms and set up your account for fuel and service purchases.

Company Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Have you spoken with a company representative

Phone Number

Fax Number

Email Address for Invoices

Accts Payable Contact

Federal ID #

State ID #

D&B #

County

County Tax Rate

Corporate or PJ City Tax Rate

If BANK D&B

Are you taxed at any special rate?

If yes what rate?

Are you exempt from any tax?

If yes please attach an exemption certificate.

Drag & Drop Files, Choose Files to Upload

BANK REFERENCES

Name

Address

Phone/Fax #

Account #

Trade References

(Must Provide Three References)

Company Name

Phone/Fax #

Contact Persons

Authorization

I the undersigned hereby authorize R. K. Allen Oil Company, Inc. to investigate the credit history on the above company. I also understand that based on credit information, a deposit of cash or certified funds, a firm guarantee such as an irrevocable bank letter of credit, or personal guarantee may be required. **SIGNATURE MUST BE AN OFFICER OF THE COMPANY**

Signature

Clear Signature

Title

Date

Any and all fees, legal or otherwise incurred by R. K. ALLEN OIL CO., INC. in the collection of any amount due or owing pursuant to this agreement shall be the full responsibility of the debtors.