Credit Application for
Gasoline / Diesel Usage

Gasoline and Diesel Credit Application

Please fill in the gasoline and diesel credit application below.

Business Account:
Date
mm/dd/yyyy
Legal Company Name
Trade Name (DBA)
Billing Address
Ship to Address
Office Phone
Type of Business
Sole Proprietorship
Partnership
Corporation
Year Established
Annual Sales
Federal ID#:
D&B #
Owner(s) or Partner(s)
#1
First Name
Middle Name
Last Name
Residential address
Phone
#2
First Name
Middle Name
Last Name
Residential address
Phone
Major Credit References
#1
Company Name
Phone
Person to Contact
Account #
Email
#2
Company Name
Phone
Person to Contact
Account #
Email
#3
Company Name
Phone
Person to Contact
Account #
Email
Bank Reference
Name of Bank
Person to contact
Address
Type of relationship
Bank telephone
Profile Information
Monthly fuel usage (estimated monthly volume)
Monthly credit line desired ($)
Account Credit Request (Example Credit or COD)
Method of Receiving Invoices
Email
Email
Product(s) desired
Electronic Signature (email)
Signed Date
mm/dd/yyyy
Agreement
In consideration of any extension of credit, loan, or other financial accommodation heretofore, now or hereafter made to 'Account Debtor' by W. Douglass Distributing Company, LTD, the undersigned hereby guarantees absolutely and unconditionally the prompt payment when due, and at any time thereafter, of all indebtedness and obligations of every kind and nature of Account Debtor to W. Douglass Distributing Company, LTD absolute or contingent, due or to become due, now or hereafter existing, as well as any renewals, extensions or modifications of such indebtedness (the 'Indebtedness'), and in addition, the undersigned agrees to pay all expenses, including attorney fees and legal expenses, paid or incurred by W. Douglass Distributing Company, LTD to collect the Indebtedness, or any part thereof, and to enforce this guaranty. The undersigned also further agrees that all payments and obligations of Guarantor are performable in Grayson County, Texas. Guarantor further agrees that the laws of the State of Texas shall govern any transactions made between W. Douglass Distributing Company, LTD, Account Debtor and/ or Guarantor. Applicant further agrees to waive personal jurisdiction and venue in any dispute arising from, or relating to, the sale or goods or services by W. Douglass Distributing Company, LTD to ACCOUNT Debtor and/or the enforcement of this Personal Guarantee and agrees that any dispute between W. Douglass Distributing Company, LTD Account Debtor and/ or Guarantor shall be exclusively resolved in the Courts of Grayson County, Texas.

The undersigned waives presentment, protest and notice of dishonor or default, notice of acceptance of the guaranty, notice of extension of credit or other actions taken in reliance hereon, and all demands and notices of any kind in connection with this guaranty or the Indebtedness and further waives necessity of bringing suit or making legal demand on Account Debtor prior to enforcement of the guarantee. W. Douglass Distributing Company, LTD without notice of any kind, may sell, assign, or transfer any of the Indebtedness to a third party, and in such event, each successive assignee, transferee or holder of any of the Indebtedness shall have the right to enforce this guaranty for the benefit of such assignee, transferee, or holder. This guaranty shall be binding on the heirs, legal representatives, successors and assigns, of the undersigned and shall insure to the benefit of W. Douglass Distributing Company, LTD, its successors, and assigns.

The information provided on this application is complete and accurate. I authorize W. Douglass Distributing Company, LTD to inquire on our credit history. The company which I represent is financially capable and will pay W. Douglass Distributing Company, LTD all invoices according to their terms. ALL PAST DUE INVOICES ARE SUBJECT TO AN ADDITIONAL 1.5% INTEREST PER MONTH SERVICE CHARGE WHICH AMOUNT TO 18% ANNUAL PERCENTAGE RATE (APR). Collection fees, legal fees and court costs are recoverable by W. Douglass Distributing Company, LTD if the account is turned over to a third party collection agency or if legal action is taken to recover payment.
Signee
Business Name
Name
Electronic Signature (Email)
Signed Date
mm/dd/yyyy
Additional Signee
Name
Electronic Signature (Email)
Date Signed
mm/dd/yyyy
Security