Business Credit – Farmer's Union Oil Co Travel Center

BUSINESS CREDIT APPLICATION

Credit Line Request: $

Check One:

Sole Proprietor

Public Corporation

General Partnership

Limited Liability Company (LLC)

Non-Profit (tax exempt)

Federal Tax ID #:

Date Business Originated:

Company Name

Trade Name if Used:

Billing Address:

Street Address City State / Province / Region ZIP / Postal Code Country

Office Phone:

Cell Phone:

Statements/Invoices Emailed:

Yes

Email Addres:

Number of Cards Needed:

Card Numbering Preference:

Yes

(If yes, please provide a preference)

Owners, Officers, Members, or Partners (Please list)

Name

First Last

Title:

Social Security Number:

Date of Birth:

Primary Contact:

Phone:

Total Business Assets $:

Liabilities $:

Net Worth $:

Credit References

Primary Lender Name:

First Last

Contact Person:

First Last

Email:

Phone:

Other Lender Name:

First Last

Contact Person:

First Last

Email:

Phone:

Primary Supplier Name:

First Last

Contact Person:

First Last

Email:

Phone:

Credit Policy – Charge Account Agreement

Signature(s):

Date:

For Office Use Only:

Approved by:

Date Approved:

Amount Approved:

BUSINESS CREDIT APPLICATION

Owners, Officers, Members, or Partners (Please list)

Credit References

Credit Policy – Charge Account Agreement

For Office Use Only:

GET DAILY DEALS

(218) 386-1318

CONVENIENCE HOURS: 5:00 AM TO 8:00 PM

ENERGY HOURS: 8:00 AM TO 5:00 PM

DIESEL AND GASOLINE - 24 HOUR PAY AT THE PUMP