Credit Application - Chief Petroleum

MAIN PLANT OPERATIONS AT:
301 S. 10th Street, Box 6239, Colorado Springs, CO 80934
PHONE: (719) 473-7760
FAX: (719) 633-1163
Business Name*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Federal ID Number*
TYPE OF BUSINESS: Corporation; give state of incorporation: *
Year*
Type of Business*
Nature of Business*
PRINCIPAL OWNERS -- PARTNERS -- CORPORATE OFFICERS
Name*

First NameLast Name
Social Security Number
Title*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PRINCIPAL OWNERS -- PARTNERS -- CORPORATE OFFICERS
Name

First NameLast Name
Social Security Number
Title
PRINCIPAL OWNERS -- PARTNERS -- CORPORATE OFFICERS
Name

First NameLast Name
Social Security Number
Title
Credit Line
Is purchase order required:*
Types of products to be purchased:*
Will account be sales tax exempt:*
Desired credit limit:*
Will you be using our fuel card:*
How many fuel cards:*
ACH Payments
We are pleased to offer you our direct payment service. Have your payment deducted automatically from your checking or savings account and start saving time, postage, and late fees while maintaining your good credit.

Here’s how the Direct Payment Plan works:
You authorize regularly scheduled payments to be made from your checking or savings account. Then, just sit back and relax. Your payments will be made automatically on the specified day. Proof of payment will appear on the specified day. The authority you give to charge your account will remain in effect until you notify us in writing to terminate the authorization. The direct payment plan is dependable, flexible, convenient and easy. Please complete the attached authorization form and return it to us.

For questions, call Elise Swackhamer at 719-985-5176.
I authorize Chief Petroleum to initiate electronic debit entries to my (check one):*

Checking AccountSavings Account
For payment of my Chief Petroleum invoices. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. This authority will remain in effect until I have cancelled it in writing.*

I agree
Account Name / Company:*
Accounts Payable Email:*
Financial Institution Name:*
Account Number at Financial Institution:*
Financial Institution Routing/ Transit Number:*
E-Signature:*
Date:*
Terms of Credit Agreement
In consideration for the extension of credit to the undersigned applicant (hereinafter referred to as "APPLICANT") by the Chief Petroleum Company/ Chief Petro-Card, Inc. (hereinafter referred to as "CHIEF'), APPLICANT expressly agrees to be bound by and to conform with all of the terms and conditions of this agreement:

1. APPLICANT agrees to the following term of payment; Bulk Purchases of Motor Fuels, Aviation Fuel, Kerosene and Solvents sold and invoiced by Chief Petroleum Co. Net 10 Days from date of purchase.
Bulk and Packaged Lubricants and Anti-freeze sold and invoiced by Chief Petroleum Co. Net 30 Days from date of purchase.

Motor Fuels purchased at Chief Petro-Card and CFN affiliated card-lock locations and all other transactions invoiced by Chief Petro-Card. Statments / invoices are mailed on the First and Fifteenth of each month and are due 15 Days from the statement / invoice date.

2. Any amount not paid in full on or before a payment due date shall accrue interest at the rate of 18 percent per annum from the payment due date until paid in full.

3. APPLICANT agrees that in the event of nonpayment or any other default in APPLICANT'S performance of his obligations under this agreement, they shall pay to CHIEF all costs and expenses, including reasonable attorney's fees and/or collection agency fees incurred in enforcing any of the provisions herein, including but not limited to, attorney's fees incurred during any judgment collection process.

4. This agreement shall be interpreted in accordance with the laws of the State of Colorado, and jurisdiction and venue for any action under this agreement shall be in El Paso County, Colorado.

5. APPLICANT warrants and represents that all of the information provided in this credit agreement and in the accompanying application for credit is true and accurate, and it is expressly offered to CHIEF so that they may rely upon it in granting credit.

6. APPLICANT hereby expressly authorizes CHIEF, or its designated agent to contact any of the above credit references, banks or financial institutions or other persons or agencies who have extended credit
to the APPLICANT, and said persons or entities are hereby authorized to provide all available credit information to CHIEF.

7. APPLICANT agrees that he shall be liable for all charges and transactions made to any and all fuel cards issued by CHIEF to APPLICANT pursuant to this agreement. Further, APPLICANT agrees that in the event a
fuel card issued hereunder is lost or stolen, APPLICANT is liable for any and all charges or transactions made by said card until CHIEF has been notified of said loss or theft.

Notice to CHIEF can be made in person at CHIEF'S 301 South 10th Street office, by phone (719) 473-7760 during normal business hours, or by registered mail.

8. If any clause or provision of this agreement is illegal, invalid or unenforceable under applicable, present or future laws, the remainder of this agreement shall not be effected and will remain in force.
Signed by:*

First NameLast Name
Title*
Signed by:

First NameLast Name
Title
Dated this date of:

MonthDayYear
Date
I agree that all billing discrepancies must be filed within 30 days of receipt of invoice*

I agree
Should be Empty:

PRINCIPAL OWNERS -- PARTNERS -- CORPORATE OFFICERS

PRINCIPAL OWNERS -- PARTNERS -- CORPORATE OFFICERS

PRINCIPAL OWNERS -- PARTNERS -- CORPORATE OFFICERS

Credit Line

ACH Payments

Terms of Credit Agreement