• Please provide the following information:

  Complete Business name  (required)

  Billing address
  Address (cont.)
  City
  State
  Zip code

  Shipping address
  Address (cont.)
  City
  State
  Zip code
  Business  Phone (required)
  Business Fax
  Is the Business	Corporation Partnership DBA Sole_Proprietorship Limited_Liability

  Nature of Business
  Years There
  Products you intend to purchase

  Federal ID#
  NOTE	If you are Tax Exempt, Please complete an exemption form located here. Unless we have a completed form, sales tax will be charged.

  Credit References

  Bank name
  Contact name
  Address
  Phone
  Account#

  Trade References

  Name
  Contact name
  Address
  Phone
  Fax#

   

  Name
  Contact name
  Address
  Phone
  Fax#

   

  Name
  Contact name
  Address
  Phone
  Fax#

  
  Contact Information

  Acct. Payable Name

  Phone

  Operations Name
  Phone
  Emergency Name
  Phone

  To induce Ullman Oil Company Inc. to extend credit and continue to extend credit, the undersigned, individually, jointly and severally do hereby each personally and personally guaranty to Ullman Oil Company Inc. payment of all sums when due(including, without limitation, interest, late charges and other fees) for products and/or merchandise ordered by, produced for or shipped by Ullman Oil Company Inc. to 

  Business name

  Person
  Date

  
  Disclosure Statement
  
  1. Payment due 30 days after delivery date.
  2. Staements are sent during the first week of the month. Contact us with questions or discrepancies at once.
  3. A finance charge of 1.5% per month, or 18% annually, will be assessed to all invoices past due on your account.
  Your account has  payment terms of net 10 days.
  
  Credit Application completed by

  Person

  Title
  Date

     

Authorization: 
I understand that I may submit my application to Ullman Oil, Inc. electronically by clicking "Submit Form". If I choose to submit this application electronically, I acknowledge that, regardless of whether I use a web browser with security features, Ullman Oil, Inc. is unable to ensure that the data will not be intercepted by third parties. I agree that Ullman Oil, Inc. is released from any claims and/or liability in the event that the data in this application is intercepted by third parties.

Please make sure you have read the terms and conditions. Do not submit more than one application. Before submitting your application, please verify all answers are correct.