Please fill out the fields below and hit 'Submit' to enter this application electronically.

Alternatively, hit the 'Printable Version' button to be directed to a .PDF of this form that you can print out and fax to us at 570-823-1910.

The undersigned company is applying for credit with and agrees to abide by the standard terms and conditions.

Printable Version









  1. Names, titles, and addresses of your three chief corporate officers or partners, or owner(s):







  2. Trade References

    *NOTE: All phone numbers, email addresses, and fax numbers must be current and accurate.
    IF THEY ARE NOT, YOUR CREDIT APPLICATION WILL NOT BE PROCESSED, AND ALL FUTURE ORDERS WILL NEED TO BE PAID IN FULL BEFORE PRODUCTS ARE SHIPPED. We recommend calling your trade references and confirming all credit department phone numbers, email addresses, and fax numbers prior to sending this credit application in to our credit department.

    Trade Reference #1


  3. Trade Reference #2


  4. Trade Reference #3


  5. AGREEMENT TO TERMS AND CONDITIONS

    I authorize this organization to request a consumer and business credit report for purposes of determining my current and continued credit worthiness. The permissible purpose(s) for which the report is being obtained certifies the report will not be used for any other purpose. I understand that this organization will be requesting a consumer credit and business report in conjunction with this commercial business application. I release all such persons from any liability or damages that may be incurred as a result of such information. I certify that the information on this application is true and complete. Additionally, I agree to all of terms and conditions as outlined below.

    GENERAL TERMS AND CONDITIONS

    IN CONSIDERATION OF SELLER, Petroleum Service Company, INC., SELLING GOODS AND/OR SERVICES TO THE BUYER EXECUTING THIS APPLICATION AND AGREEMENT, BUYER AGREES TO THE FOLLOWING TERMS AND CONDITIONS REGARDING PURCHASES MADE HEREAFTER:

    1. 1. ALL SOLVENT & LUBRICANT PURCHASES SHALL BE PAID NO LATER THAN 30 DAYS FOLLOWING THE INVOICE DATE. ALL FUEL PURCHASES SHALL BE PAID NO LATER THAN 15 DAYS FOLLOWING INVOICE DATE.
    2. 2. IN THE EVENT THAT FULL PAYMENT IS NOT RECEIVED WITHIN TERMS STATED IN ITEM 1, NO FURTHER CREDIT WILL BE EXTENDED UNTIL ACCOUNT BALANCE IS SATISFIED. FURTHER CREDIT MAY BE CURTAILED WITHOUT PRIOR NOTICE TO BUYER.
    3. 3. BUYER AGREES TO PAY SELLERS ATTORNEY FEES, COURT COSTS,AND EXPENSES INCURRED BY SELLER IF BUYERS ACCOUNT AND THIS AGREEMENT ARE REFERRED FOR COLLECTION OR ENFORCEMENT.
    4. 4. BUYER AGREES TO PAY SERVICE CHARGES OF 1-1/2% PER MONTH, AN ANNUAL INTEREST RATE OF 18% PER ANNUM ON ANY AMOUNTS PAST DUE 30 DAYS AFTER BILLING DATE.
    5. 5. IF IT BECOMES NECESSARY FOR SELLER TO INSTITUTE LITIGATION AGAINST BUYER IT IS AGREED THAT SELLER HAS THE RIGHT TO BRING SUIT IN THE COUNTY OF LOS ANGELES, CALIFORNIA.
    6. 6. NOTWITHSTANDING THAT THIS ACCOUNT IS ESTABLISHED IN THE NAME OF A COMPANY, BUYER PERSONALLY GUARANTEES PAYMENT OF THIS ACCOUNT.
    7. 7. BUYER WARRANTS THAT THE ABOVE INFORMATION IS TRUE AND CORRECT AND ACKNOWLEDGES THAT CREDIT WILL BE EXTENDED PURSUANT TO THIS AGREEMENT.
    8. 8. ANY DISPUTE AS TO BILLING, CHARGES, OR MATERIALS MUST BE RAISED BY BUYER WITHIN 10 DAYS OF BILLING OR SAID DISPUTE SHALL BE WAIVED BY BUYER.
    9. 9. SELLER RESERVES THE RIGHT TO CHARGE MASTERCARD, VISA, OR AMERICAN EXPRESS ACCOUNT FOR ANY PAST DUE AMOUNTS.


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