|
||||||||||||||||||
|
NEW ACCOUNT APPLICATION Your Name ___________________________________________________________ Date __________________________ Company ________________________________________________ (d.b.a. if applicable) __________________________ Street Address ____________________________________________ Years in business _____ Years at this location _____ City ____________________________________________________ State _________ Zip _________________________ Phone ___________________________ Fax ______________________________ E-mail _________________________ Accounts Payable Contact _______________________________________________ Phone _________________________ REFERENCES Current Fuel or Lubricant Suppliers, if any: Supplier 1 ____________________________________________________________ Phone _________________________ Supplier 2 ____________________________________________________________ Phone _________________________ Other Trade References: Vendor 1 _____________________________________________________________ Phone _________________________ Vendor 2 _____________________________________________________________ Phone _________________________ Bank References: Bank _____________________________ Contact ____________________________ Phone _________________________ Account No. _______________________ Address __________________________________________________________ Bank _____________________________ Contact ____________________________ Phone _________________________ Account No. _______________________ Address __________________________________________________________ TERMS OF SALE If credit is extended to applicant, the undersigned agrees to our terms of sale; which are net 15 days from date of invoice. Payment is required from invoice and no statement will be mailed. Accounts with balances beyond our terms are subject to interruption of deliveries and/or 1.5% per month service charge on balances over 15 days. The undersigned agrees to pay, in the event of default, all reasonable attorneys’ fees and the cost and expenses of collection of this account, and amounts due hereunder. The undersigned consents to the jurisdiction of Massachusetts courts for all action instituted hereunder, and agrees that Massachusetts law shall govern. We accept the terms shown above and authorize Dennis K. Burke, Inc. to obtain information concerning the above statement so that our accounts can be opened. Authorized by ______________________________________________ Title _____________________________________ Signature X _______________________________________________ Date _____________________________________ ___________________________________________________________________________________________________INFORMATION BELOW WILL BE FILLED IN BY DENNIS K. BURKE, INC. Originator _____________________________ Date ___________________ Estimated Monthly Sales ($) ______________ Products: __ Low Sulfur Diesel __ High Sulfur Diesel __ #2 Heating Oil __ Kero __ Gasoline __ Lubes __ Purchase Order required __ Resale certificate endorsed __ All applicable federal and state tax will be charged Approved Date ________________________ Amount $_________________ Terms ______________________________ Credit Manager _______________________ Comments ______________________________________________________
|
||||||||||||||||||
|
284 Eastern Avenue |
When complete, please fax to (617) 884-7638 Need a Mass. State ST-4 Form, click here now. For more information contact credit@burkeoil.com © 2001 Dennis K. Burke, Inc. All rights reserved. |
|||||||||||||||||
