New Customer Info Go Paperless My Account Home Apps Delivery Plans Equipment & Service Lubricants Stores Contact Commercial Credit Application The following form is submitted over a secure connection and is encrypted for your security. If you would prefer to fill out a paper application, you can download and print the form here then mail it to the appropriate address. Please enter the following information to start the application process. Be sure to provide complete and accurate information. Company Information Company Name: Federal ID #: Street Address: City: State: Zip: Mailing Address: City: State: Zip: Phone: Fax: Email Address: Type of Business: Years In Business: Incorporated Partnership Sole Proprietor LLC Is This Business Sales Tax Exempt: No Yes (If Yes, you will need to provide a signed copy of your certificate.) Purchase Orders Required: No Yes Issued By: Accounts Payable Clerk: Owners or Principles: Name: SSN: Phone: Address: Name: SSN: Phone: Address: Name: SSN: Phone: Address: Credit References Previous Supplier: Address: Phone: Bank References Bank Name: Account #: Phone: Fax: Bank Name: Account #: Phone: Fax: Bank Name: Account #: Phone: Fax: Trade References Reference Name: Account #: Phone: Fax: Reference Name: Account #: Phone: Fax: Reference Name: Account #: Phone: Fax: Delivery Site 1 Location: Product: (#2 fuel, kerosene, propane, etc.) Tank Size: Delivery Schedule: Automatic Fill Will Call Estimated Annual Gallons: Propane Use (check all that apply): Cook Stove Clothes Dryer Primary Heat Secondary Heat Hot Water System: Oil Propane Other Delivery Site 2 Location: Product: (#2 fuel, kerosene, propane, etc.) Tank Size: Delivery Schedule: Automatic Fill Will Call Estimated Annual Gallons: Propane Use (check all that apply): Cook Stove Clothes Dryer Primary Heat Secondary Heat Hot Water System: Oil Propane Other Delivery Site 3 Location: Product: (#2 fuel, kerosene, propane, etc.) Tank Size: Delivery Schedule: Automatic Fill Will Call Estimated Annual Gallons: Propane Use (check all that apply): Cook Stove Clothes Dryer Primary Heat Secondary Heat Hot Water System: Oil Propane Other Delivery Site 4 Location: Product: (#2 fuel, kerosene, propane, etc.) Tank Size: Delivery Schedule: Automatic Fill Will Call Estimated Annual Gallons: Propane Use (check all that apply): Cook Stove Clothes Dryer Primary Heat Secondary Heat Hot Water System: Oil Propane Other Service Site 1 Location: Furnace Manufacturer: Service Contract: Home Comfort Plan Founders Plan Service Site 2 Location: Furnace Manufacturer: Service Contract: Home Comfort Plan Founders Plan Submit Application Agreement - Please Read Before Signing I understand and agree to the following credit terms that invoice amounts are due and payable 30 days from the date of the invoice. Past due balances are subject to a 1.5% late charge (18% per annum). Also, I have read and agreed to the terms and conditions shown below. COD restrictions may be placed on any account at any time. Applicant Name: Applicant Signature (Initials): Applicant Title: Further, I personally accept full responsibility for all sums due, and agree to the terms and conditions of invoices incurred by the above named account. I understand and agree that by submitting these forms electronically, I authorize these forms to be as valid as manually signed forms submitted on paper. I further authorize my typed name and initials to be as valid as a manual signature and initials. Applicant Name: Applicant Signature (Initials): Applicant Title: This signed application serves as authorization for A.E. Robinson Oil Co. Inc., to obtain credit information on the above named account. The Federal ECOA prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status or age. If you're not a robot, what is 500 + 97? A.E. Robinson Oil Company Inc. Credit Policy The following CREDIT POLICY is written and adopted to meet Federal and State Credit Laws. A.E. Robinson Oil Company will not discriminate in granting credit on the basis of race, color, religion, or marital status. ALL BILLS ARE DUE UPON PRESENTATION. All account balances, which are unpaid after thirty (30) days from the billing date, are overdue. Terms are net 30 days. CREDIT to approved accounts only. Credit approval is determined via a signed, completed credit application. Upon review of the application, an approval or denial letter shall be sent within 48 hours. LATE CHARGES will be imposed on all overdue account balances at the rate of 1.5% per month (18% per annum). AUTOMATIC DELIVERY is determined by A.E. Robinson Oil Company based on credit approval and/or credit history. ALL propane accounts must be on automatic delivery. WILL CALL DELIVERY A customer may call when he/she wishes product to be delivered. A.E. Robinson Oil Company shall deliver WCA on the next scheduled delivery day without a delivery charge. C.O.D. ACCOUNTS require payment before or at the time of delivery. A C.O.D. account must submit a new credit application to be returned to Open Charge status. PRE-BUY A customer may pre-buy a specific amount of fuel for a designated price per gallon as described in a Pre-buy agreement. Payment and the original form must be submitted by the established deadline. Photocopies are not acceptable. Pre-buy is available to any customer with a zero balance. BUDGET ACCOUNTS A customer with a zero balance and approved credit may request a budget account. Monthly payment amounts are determined by estimated usage for a twelve (12) month period and may include a service contract. Accounts failing to remit two (2) consecutive payments will be removed from the Budget Plan, returned to standard pricing, taken off automatic delivery and placed on C.O.D. COLLECTION COST shall be added to all accounts. Costs may include, but not limited to, fees paid to the Court, Law Enforcement Agencies, Collection agencies, Attorney and paralegal fees and every other cost or expense that is incurred to collect accounts that are past due. Copies of all collection costs shall be provided at the customer's request. PUMP OUT charge of $120.00 will be charged for removing fuel from a tank. CHANGE OF OWNERSHIP I/We understand that we must notify A.E. Robinson Oil Co. in writing and by certified mail of any change in ownership, the name of business or structure of the business under which credit is established. 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