Apex Oil
Company, Inc.
314-889-9600 Fax: 314-889-0299
New Account
Application
Full Legal
Name_____________________________ Type of Business_______________
Billing
Address__________________City_______________State_____Zip___________
Phone # _________________
Fax # _________________ Date Started ______________
Type of ownership:
Corporation ___ Partnership ___ Proprietorship ___ Fein # ________
Amount of Credit requested
__________________ Type of products ________________
Accounts payable contact
_________________________ Phone # __________________
Bank
References:
1. Name
______________________________________ Phone # ___________________
Account Officer _______________________Address
____________________________
Fax No.
___________________Acct. numbers_________________________________
2. Name
______________________________________ Phone # ___________________
Account Officer _______________________Address
____________________________
Fax No.___________________ Acct.
numbers_________________________________
Petroleum
Suppliers
1. Name
________________________ Contact _________________________________
Fax no. _______________________
Phone ________________ Acct. # _____________
2. Name
________________________ Contact _________________________________
Fax no.
_______________________ Phone ________________ Acct. # _____________
3. Name
________________________ Contact _________________________________
Fax no.
_______________________ Phone ________________ Acct. # _____________
Financial
Statements: REQUIRED
Can be requested
from__________________________________ Phone______________
Taxable
Status: (indicate applicable number & attach all certificates)
Federal Excise tax: Gasoline
____________________ Diesel ______________________
Ship to: Location #1
____________________ Location #2 ________________________
Taxes:
______________________________ ________________________
State motor/special fuel tax
______________
________________________
State sales tax
_________________________
________________________
State export tax
________________________
________________________
State inspection tax
_____________________
________________________
State transportation tax
__________________
________________________
The undersigned hereby authorizes Apex Oil Company, Inc. to contact any person or business referenced in this application for the purpose of obtaining a credit reference and/or verifying the information submitted.
_________________________ __________________________ ________________ ________________________
Signature Title Date Name (printed)