POOLE OIL

	"When in Need of Fuel - Think of Poole" 87 SE 7th Ave - PO Box 309 Ontario, OR 97914 Phone (541) 889-3128 or (800) 653-4125 FAX (541) 881-1465
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NEW ACCOUNTS APPLICATION

Please type in the following information on your screen.
Print this screen on your printer.
SIGN in Both Signature Boxes
FAX to Poole Oil at (541) 881-1465

Are you presently a Pacific Pride or AmeriNet Cardholder? Yes No
If Yes, Card #: When did you last use your card?
Full name of Firm: Phone#:
Fax#:
Mailing Address, City, State, Zip:
Street Address, City, State, Zip:
Home/Head Office Address:
Home/Head Office Phone Number:
CHECK APPROPRIATE BOX AND PROVIDE INFORMATION AS REQUESTED:
Single Entity (not a subsidiary) Partnership		How long in Business?
Subsidiary of Parent Company Other Type of Business:
Name of Parent Company:
Address of Parent Company:
Corporation State:	FEDERAL ID#:
Under what other company names have you operated?:
If in business less than two years - please provide employment information for the last five years: Company name: Company Address: Time Employed:




PLEASE LIST THE NAMES AND TITLES OF PARTNERS OR CORPORATE OFFICERS:
Names / Titles: Address/City/State/ Zip: Phone Number:



Applicant/Owner/Officer: Title:
Spouse's Name:
Home Address, City, State, Zip:
How Long?: Own? Buying? Renting?
Previous Address, City, State, Zip:
How Long at Previous Address?
Home Phone: Social Security #:
Driver License # / State of Issue: Date of Birth:
Name of Relative not living with you: Relationship:
Relative phone number:
Have you ever filed Bankruptcy? Spouse also, if an officer:
Yes No Personally Business
If so, when? Where? City/ State:
Net Monthly Income:
REFERENCES
Bank Name and Branch:
Bank City, State: Phone #:
Name of Bank Officer: Account #:
Current Petroleum Supplier Name: Phone #:
Current Petroleum Supplier Address:
Alternate Supplier Name:Phone #:
Alternate Supplier Address:
Trade Reference: Acct #:Phone #:
Trade Reference: Acct #:Phone #:
Estimated Monthly Usage Gallons: $ Amount:
Accounts Payable Contact: Phone #:
Person(s) to contact regarding arrangements for cards:
Phone #: Cellular Phone #:
SIGNATURE:_______________________________TITLE:___________________DATE:_____________

ADDITIONAL TERMS CARDLOCK USE
1) Purchases will be for vehicles owned or operated by the Purchaser. 2) This access card is used to initiate a Pacific Pride or AmeriNet transaction. This access card is not a credit card. 3) Minimum purchase of 900 gallons per year from all fuel sources is required if CLASS 1 FLAMMABLES (gas) are purchased. 4) In the event that any legal action is required to collect on this account, venue for such legal matters will be determined by supplier. 5) Purchaser shall be responsible for all purchases by Purchaser or any other persons using cardlock cards issued to Purchaser, regardless of whether use by any other person is unauthorized or fraudulent. 6) If there is any change in the ownership of Purchaser or if substantially all of the assets of Purchaser are sold, Purchaser shall promptly notify Supplier of such sale and Supplier shall have a lien on all the assets of Purchaser and a lien on the proceeds of such sale to secure payment of all outstanding sums owning to Supplier. 7) Purchaser represents that it and any person using the cardlock cards delivered to Purchaser are and shall be aware of the proper use of the cardlock system and shall use safe practices in compliance with the regulations of the local Fire Code in the handling of the fuels dispensed from the cardlock system. The Purchaser agrees to indemnify and hold Supplier harmless from any claims and costs including, but not expressly limited to, those for bodily injury and property damage which may be occasioned by the negligence of misuses of the cardlock system by the Purchaser of any person using the cardlock cards delivered to the Purchaser hereunder. 8) Supplier shall use its best efforts to maintain the cardlock system in good working order and condition at its expense provided however Supplier shall not be responsible for any damage or loss which may result from its failure to provide fuel or the failure of the cardlock system in any manner whatsoever Purchaser agrees that it and any person using the cardlock cards delivered to the Purchaser shall promptly notify Supplier of any malfunctioning of the cardlock system of which Purchaser of such person is aware. 9) Purchaser's right to purchase fuel through the cardlock system may be terminated immediately upon any breach of any of the terms hereof or of any other agreement with Supplier. Upon termination, Purchaser agrees to immediately surrender all cardlock cards issued to Purchaser and to immediately pay all outstanding sums owing to Supplier. Supplier shall refund any deposit to Purchaser when all cards are returned and all amounts owing to Supplier are paid in full. 10) In the event of any breach of any of the terms of this agreement or any other agreement between Purchaser and Supplier, including but expressly not limited to the failure to pay sums owing to Supplier when due, then in addition to any other sums due of payable to Supplier by Purchaser, Purchaser agrees to pay the reasonable attorney fees and costs incurred by Supplier in the enforcement of Supplier's rights even though no suit or action in filed and if suit of action is filed to enforce the rights of Supplier then such further sum as the court may adjudge reasonable as attorney fees at trial or on appeal of such suit or action in addition to all other sums provided by law. 11) All terms and conditions of this Agreement and Guaranty are intended to cover Purchaser's account as well as all of Purchaser's branch accounts, whether set up now or in the future. 12. A $25.00 handling fee will be charged for all checks returned from the bank for any reason.
AGREEMENT AND GUARANTY I have made the attached statements for the purposes of obtaining credit. I certify they are true and authorize you to make a full credit investigation. Billings shall be issued twice each month and payments will be due within the 10 days of invoice date. I agree to pay a late charge of 2% per month (24% per year) or 75 cents minimun on any delinquent balances. THIS AGREEMENT INCLUDES THE TERMS AND CONDITIONS ON THIS APPLICATION HEREOF. Not withstanding that this account is established in the name of a company, I personally guarantee payment of the account. All purchases made on this account will be for commercial use. Signed:_______________________________________________________ Printed Name:_____________________________________________ Date:________________

Thank you for completing Poole Oil's
New Account Application form.

Please print this screen on your printer.
SIGN in Both Signature Boxes and
FAX to Poole Oil at (541) 881-1465