***BEFORE SIGNING PLEASE READ***

545 Lyell Ave. Rochester NY 14606

(585)254-9200 (800)777-9200 Fax: (585)458-7390 www.emersonoil.com
Commercial Credit Application
How long have you been in business?*
Types of products you wish to purchase?*
Salesperson:*
Business Name*
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Delivery Address*

Street Address

Street Address Line 2

CityState / Province

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Phone Number*

Area CodePhone Number
Fax Number*

Area CodePhone Number
Federal ID # or Social Security Number *
Type of Ownership *
Taxable Status*
Please attach a tax exempt certificate if not taxable*

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Bank Reference
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Branch*
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Fax Number*

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Account #*

Trade References
1.) Company Name *
Address*

Street Address

Street Address Line 2

CityState / Province

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Contact Person *
Phone Number*

Area CodePhone Number
Fax Number *

Area CodePhone Number
2.) Company Name *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Person *
Phone Number*

Area CodePhone Number
Fax Number *

Area CodePhone Number
3.) Company Name *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Person *
Phone Number*

Area CodePhone Number
Fax Number *

Area CodePhone Number

***BEFORE SIGNING PLEASE READ***
1) Terms - Payment due within terms stated on invoice. All accounts with a balance over thirty (30) days are considered past due for the purpose of assessing finance charges. Finance charges are computed by applying a periodic rate of 1 1/2 % per month (which is equivalent to an annual percentage rate of 18 %).

2) In the event that payment is past due, and the matter is turned over to an attorney or to a collection agency for collection, you will be responsible for all costs of collection, including court costs, filing fees, and reasonable attorney's fees and/or collection agency fees.

3) I certify that I have read this application thoroughly and accept its conditions, and further state that all information is true and correct and made for the purpose of obtaining credit. I hereby authorize Emerson Oil Co., Inc., now and at other times, to secure information from credit reporting agencies and others about the company or individual(s) whose credit Emerson Oil Co., Inc. is relying on, and I authorize Emerson Oil Co., Inc. or any credit reporting agency employed by Emerson Oil Co., Inc. to investigate references herein or other information relating to our credit.
IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL:
If you think your bill is incorrect, or if you need more information about a transaction on your bill, contact us in writing within 40 days of the original invoice date. You do not have to pay any amount in question while we are investigating but you are still obligated to pay the parts
of the bill that are not in question. While we are investigating, we cannot report you as delinquent or take any action to collect the amount in question.

Until credit is approved, the account will be on a cash on delivery (COD) basis.
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545 Lyell Ave. Rochester NY 14606

Commercial Credit Application

Bank Reference

Trade References

***BEFORE SIGNING PLEASE READ***

IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL:

BEFORE SIGNING PLEASE READ