 |
Commercial
New Customer Information
|
Company Name:
Delivery Address:
City: Zip:
Township: County:
Tax Identification #:
Primary Contact:
Is Billing Address the Same? Yes No
If not, Billing Address:
City: State: Zip:
Office Telephone: Fax:
Desired Method of Delivery: Keep Full Will Call Desired Method of Payment: NET 30 Prepay
| Product Grade | Tank Size | Tank Color | Tank Location | |
|---|---|---|---|---|
| Gas |
|
|
|
|
| Off Road |
|
|
|
|
| On Road |
|
|
|
|
| Home Heat |
|
|
|
|
Directions:
NOTE: Commercial Accounts are also required to complete a Credit Application and Tax Status Form
|
FOR OFFICE USE ONLY Type Of Customer: Farm Use Home Heat Commercial Tax Status: Industrial Process Government |
Date Of Application: Employee: Credit Status Credit Approved Credit Declined Credit Delivery Status Keep Full Will Call One Delivery Quoted Price: $ |