New Customer Credit Application

Office (541) 459-2255 Toll Free 1-888-459-8379
Home Company History New Customer Application Cardlock Fueling Sites

NEW CUSTOMER CREDIT APPLICATION
Barnes Fuel Oil - Roseburg Heating Oil

Please type in the following information on your screen.
Print this screen on your printer.
SIGN in BOTH Signature Boxes FAX to: (541) 459-5143

ACCOUNT INFORMATION:

BILL TO (Name): YOUR NAME, IF DIFFERENT:
BILLING ADDRESS:CITY, STATE, ZIP:
PHONE:FAX:CELL:
E-MAIL ADDRESS:

TYPE OF APPLICATION (Check any that apply):

CFN CARDLOCK: GASOLINE ON ROAD DIESEL OFF HWY DIESEL
NUMBER OF CARDS REQUESTED:
OREGON PUC? OREGON PUC NUMBER:

HEATING OILS: KEROSENE HEATING OIL FURNACE HEATING OIL
TANK SIZE: KEEP FULL: AUTOMATIC:

SALES AND SERVICE REPAIR AND MAINTENANCE

PORTER FLOOR FURNACE, WALL FURNACE OR PARTS

BUSINESS CREDIT REFERENCES:

REF #1 NAME: ADDRESS:
ACCOUNT NUMBER: PHONE:
FAX:

REF #2 NAME: ADDRESS:
ACCOUNT NUMBER: PHONE:
FAX:

REF #3 NAME: ADDRESS:
ACCOUNT NUMBER: PHONE:
FAX:

INFORMATION FOR BUSINESS APPLICATIONS:

TYPE OF BUSINESS: SOLE PROPRIETORSHIP PARTNERSHIP CORP. LLC
YEARS IN OPERATION:
PRESIDENT: VICE PRESIDENT:
BANK NAME AND BRANCH

INFORMATION FOR INDIVIDUAL APPLICANTS AND BUSINESSES

NAME:         HOME PHONE:
DATE OF BIRTH:    SOCIAL SECURITY NUMBER:
EMPLOYER:
EMPLOYER’S ADDRESS:
EMPLOYER’S PHONE NUMBER:
SPOUSE’S NAME:
SPOUSE’S SOCIAL SECURITY NUMBER:
SPOUSE’S EMPLOYER:

AGREEMENT AND TERMS
BY SIGNING BELOW, I AM ASKING BARNES FUEL OIL AND ROSEBURG HEATING OIL TO OPEN AN ACCOUNT IN THE NAME OF THE PRIMARY APPLICANT LISTED UNDER "BILLTO" ON THIS APPLICATION FORM (HEREAFTER REFERRED TO AS "CUSTOMER"). CUSTOMER AUTHORIZES BARNES FUEL OIL TO OBTAIN PERSONAL CREDIT REPORT AND TO MAKE WHATEVER INQUIRIES DEEMED NECESSARY TO ESTABLISH CREDIT.

CARDLOCK ACCOUNTS ARE BILLED AS OF THE 15^TH AND THE LAST DAY OF THE MONTH AND PAYMENT IS DUE UPON RECEIPT OF INVOICE. NONPAYMENT OF CURRENT CHARGES BY THE CONSECUTIVE BILLING DATE WILL CONSTITUTES AS A DEFAULT OF THE CONTRACT AND CREDIT PRIVILEGES WILL BE TERMINATED UNTIL PAYMENTS ARE RECEIVED OR BARNES FUEL OIL DEEMS APPROPRIATE.

HEATING OIL AND SERVICE CUSTOMERS ARE BILLED ON THE LAST DAY OF THE MONTH AND PAYMENT IS DUE BY 10^TH OF FOLLOWING MONTH. NONPAYMENT OF CURRENT CHARGES BY THE CONSECUTIVE BILLING DATE WILL CONSTITUTE AS A DEFAULT OF THE CONTRACT AND CREDIT PRIVILEGES WILL BE TERMINATED UNTIL PAYMENTS ARE RECEIVED OR BARNES FUEL OIL DEEMS APPROPRIATE.

NONPAYMENT OF CURRENT CHARGES BY THE CONSECUTIVE BILLING DATE WILL CONSTITUTE AS A DEFAULT OF THE CONTRACT AND CREDIT PRIVILEGES WILL BE TERMINATED UNTIL PAYMENTS ARE RECEIVED OR BARNES FUEL OIL DEEMS APPROPRIATE.

CUSTOMER AGREES TO PAY FINANCE CHARGE AT THE RATE OF 1-1/2% MONTHLY (18% APR) OF TOTAL MONTH (AFTER APPLYING ALL PAYMENTS AND OR CREDITS) REMAINING UNPAID 30 DAYS OR MORE. CUSTOMER AGREES TO PAY ANY AND ALL EXPENSES INCURRED BY BARNES FUEL OIL (INCLUDING FEES FOR LEGAL SERVICES OF EVERY KIND) TO COLLECT, DEFEND OR ASSERT THE RIGHT OF BARNES FUEL OIL TO OBTAIN THE PAYMENT OF EXPENSES AND INDEBTEDNESS RELATING TO THIS ACCOUNT.

I/WE CERTIFY THAT ALL INFORMATION ON THIS APPLICATION IS CORRECT AND THAT I/WE FULLY UNDERSTAND BARNES FUEL OIL’S CREDIT TERMS. I/WE AGREE TO ALL THE TERMS OF THIS AGREEMENT IN CONSIDERATION OF CREDIT EXTENDED.

SIGNATURE:____________________________________

NAME, PRINTED:TITLE:DATE:

SIGNATURE:____________________________________

NAME, PRINTED:TITLE:DATE:

PERSONAL GUARANTEE:
I/WE: , OF , CITY OF,
COUNTY OF , STATE OF GUARANTEE FAITHFUL AND COMPLETE PERFORMANCE OF THIS WRITTEN CONTRACT AND GUARANTEE PAYMENT OF ALL DAMAGES, COSTS AND EXPENSES OF WHICH MAY BE LIABLE WITH RESPECT TO THIS CONTRACT.

SIGNATURE:____________________________________

NAME, PRINTED:TITLE:DATE:

SIGNATURE:_____________________________

NAME, PRINTED:TITLE:DATE:

Thank you for your interest in Barnes Fuel Oil and
for completing the New Customer Credit Application form.

Please print this screen on your printer.
SIGN in BOTH Signature Boxes FAX to: (541) 459-5143