Apex Oil Company, Inc.

8235 Forsyth Blvd.  Suite 400  Clayton, Mo 63105

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

Attached__ Sent to credit department___

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 __________________                  ________________________

Miscellaneous 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)