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Thursday Nov 20, 2008
Credit Application
 
The undersigned company is applying for credit with and agrees to abide by the standard terms and conditions as stated below.
Company Name
DBA (if different)
Contact Person
Contact Email
Address
City State Zip
Phone Fax
Federal Tax Id or Social Security Number
Type of Business Number of Employees
Date Business Established Purchase Order Required
Business Entity Form
Amount of Credit Requested
Authorized Purchasers
ACCOUNTS PAYABLE CONTACT INFORMATION
Name
Phone/Fax
Email
NAMES & ADDRESS OF ALL PRINCIPALS WITH 20% OR MORE OWNERSHIP IN THE BUSINESS
TRADE REFERENCES
Reference #1
Name
Address
Phone/Fax
Reference #2
Name
Address
Phone/Fax
Reference #3
Name
Address
Phone/Fax
Bank References
Bank #1
Name
Address
Phone
Account #
Bank #2
Name
Address
Phone
Account #
Has the Business or any of its Principals with 20% ownership or more ever filed for bankruptcy?
If yes, please explain
I hereby certify that the information I have provided in this Open Account Application for Credit is complete and accurate to the best of my knowledge;
I hereby warrant that I have the authority to authorize, and hereby do authorize, an investigation of credit of the Business and each principal with ownership of 20% of more in the Business by Rhinehart Oil Co./Harts Gas & Food. I understand that the credit history obtained in, and in connection with, this Open Account Application or Credit will be used in determining the Business' eligibility for credit approval by Rhinehart Oil Co./Harts Gas & Food, and its successors and assigns. If approved, Rhinehart Oil Co./Harts Gas & Food, and its successors and assigns, may obtain credit information about the Business and each principal with ownership of 20% or more in the Business on an ongoing basis in connection with this extension of credit for any one or more of the following reasons: (1) reviewing the account; (2) taking collection action on the account; or (3) any other legitimate purpose associated with the account; and,
I have read the terms and conditions stated below and agree to all of these terms and conditions.
Authorized Name
Title
Date
General Terms and Conditions

Payment Terms: Net 30 days from invoice date. Payment must be received before or on the due date.

Late Fees: 1.75% late fee will be added for each month past due. Customer agrees to pay all late fees.

The Signer and Business represented agree with Rhinehart Oil Co./Harts Gas & Food terms and conditions. In the event that Rhinehart Oil Co./Harts Gas & Food should have to go through a collection process to collect funds, the customer agrees to pay all reasonable collection and legal fees.

Notice to Utah Residents: As required by Utah law, you are hereby notified that a negative credit report reflecting on your credit record may be submitted to a credit reporting agency if you fail to fulfill the terms of your credit obligations.


    
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