Commercial Credit Application

Thank you for your interest in Chapp Oil. To help us establish credit terms, please execute this application in it's entirety. If credit terms requested are in excess of $30,000 please send the lastest financial statements and a bank reference. Product on credit terms will not be delivered until the credit review process is complete, which usually takes 3-4 business days.

* = Required Field

HOW DID YOU HEAR ABOUT US? *

BUSINESS INFORMATION:

Legal Name of Business *

Federal Tax ID Number *

Main Phone *

Main Email *

Name of Accounts Payable *

Email Address of Accounts Payable *

Billing Address *

City *

State *

Zip *

Business Website *

State Incorporated *

Are You Claiming Exemptions? *

Yes

SHIP TO INFORMATION:

Ship To Address *

City *

State *

Zip *

On Site Contact *

On Site Cell Phone *

On Site Email *

BANK INFORMATION:

Name of Bank *

Name of Bank Contact *

Bank Account Number *

Bank Phone Number *

Bank Email *

Business Name *

TRADE REFERENCES: (complete with credit terms of equal or greater value than requesting from Chapp Oil)

(If you prefer to upload your trade references, please do so here. You will not be required to fill out the trade references fields).
Note: Only files under 4 MB's will be accepted.

Company Name # 1 *

Contact Name #1 *

Phone Number #1 *

Email #1 *

Company Name #2

Contact Name #2

Phone Number #2

Email #2

Company Name #3

Contact Name #3

Phone Number #3

Email #3

CREDIT REQUEST:
The EFT program saves time and money, please fill out the EFT form and draft notifications will be sent by fax or e-mail. We would advise you to use EFT because of the amount of current fraud cases with USPS.

How Do You Want Your Invoices Sent? *

FAX

What is Your Preferred Payment Method? *

EFT

ACH

Credit Card

Mail-in Check

Credit Limit Requested *

Phone Number *

Fax Number *

The information provided to Chapp Oil by the applicant (herein referred to "company") including financial statement(s) is warranted to be accurate, complete, and true and shall be the property of Chapp Oil.Chapp Oil is authorized to investigate the information provided to confirm its accuracy. By signing below it is agreed if Chapp Oil extends credit, any and all if its invoices shall be paid by the company within 20 days of it/their date, and shall be considered an incorporated, confirmatory writing to this agreement. Either party may terminate this agreement at any time, with the understanding all goods and services provided by Chapp Oil at the time of termination shall remain due and owing pursuant to all terms, herein. A 1.5% monthly late fee shall be charged or the maximum interest for late payments allowed by law, whichever is less. Payments which are returned will be assessed a $75.00 penalty. The company agrees to pay any and all costs and expenses, including reasonable attorney fees, incurred by Chapp Oil in collecting past due accounts. The parties hereby agree all disputes at law under $25,000 shall be resolved in the venue of the 34th District Court for Wayne County. The undersigned hereby certifies and warrants that any credit extended as a result of this application will be used solely for business purposes and will not be used for personal, family or household purposes. The signatory acknowledges receiving an exact copy of this document, and (1) agrees and acknowledges that it contains Limited Warranties and Disclaimers; (2) agrees to be bound by the terms and conditions set forth in this Agreement; and (3) agrees that the person who signs hereafter on behalf of the Company has authority to bind it.

Check to Accept Terms and Conditions
By submitting this application you are agreeing to the terms and conditions

Legal Business Name *

Name: *

Title: *

Date

Signature *

Print Name *

Date of Birth

Date

Become a Customer

Commercial Credit Application