Business Credit Application

Business Name

DBA (if different)

EIN/Federal ID Number

State of Incorporation

Year of Incorporation

On Site Contact

Accounts Payable Contact

Accounts Payable Email

Select what you want via email

Purchase Order Required?

Business Phone Number

Business Fax Number

Mailing Address

City

State

Zip

Billing Address (*if different from mailing)

Billing City

Billing State

Billing Zip

Business Type

Sole Proprietor / Officer 1 / Partner 1

Officer 1 Title (* for Corporations)

SSN (* for Sole Proprietorships)

Officer 1 Address

City

State

Zip

Officer 2 / Partner 2 (* for Partnerships & Corporations)

Officer 2 Title (* for Corporation)

Officer 2 Address

City

State

Zip

Upload a W-9 (Blank W-9)

Trade Reference 1

Name

Address

City

State

Zip

Phone Number

Fax Number

Trade Reference 2

Name

Address

City

State

Zip

Phone Number

Fax Number

Bank Reference 1

Name

Address

City

State

Zip

Phone Number

Fax Number

Bank Reference 2

Name

Address

City

State

Zip

Phone Number

Fax Number

Fill out the information below if you are interested in purchasing propane.

Tank 1
Delivery Address

City

State

Zip

Tank Size

Tank Ownership

Property Ownership

Delivery Method (Will deliver propane on route basis. Must have credit approved and remain current)

Special Requests

Tank 2
Delivery Address

City

State

Zip

Tank Size

Tank Ownership

Property Ownership

Delivery Method (Will deliver propane on route basis. Must have credit approved and remain current)

Special Requests

Fill out the information below if you are interested in tank wagon gas and diesel.

Tank 1
Delivery Address

City

State

Zip

Product

Tank Size

Special Requests

Tank 2
Delivery Address

City

State

Zip

Product

Tank Size

Special Requests

I / We are interested in more information about spring/fall fuel contracts.

Tell us if you're looking for something other than what we've listed.

CARDTROL CARD (optional)

Fill out the information below if you are interested in applying for a Cardtrol Card.

Business Name

Phone Number

Mailing Address

City

State

Zip

Number of Cards

Pin Preference

Products

Limitations for Each Transaction

Prompt

Purchase more than 10,000 gal/yr

Cardtrol Card(s) may be used to operate the fuel pumps at W & H locations in Humboldt, Fort Dodge, Eagle Grove, Renwick, Livermore, Badger, Clare, Vincent, and Goldfield.

1. Customer agrees to comply with the credit policy of W & H, which states that credit purchases are subject to a finance charge of 1.5% per month with a minimum charge of $.50 for any month in which a finance charge is imposed. No finance charge is imposed if the balance at the end of the month is paid by the 15th day of the following month and I hereby agree to pay any such charges assessed. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department.

2. In the event of a lost or stolen card, Customer agrees to immediately notify W & H Office, which will then promptly render that card invalid. Until such date and hour as Customer has so notified W & H of a lost, stolen or misplaced card, Customer shall remain liable for all purchases recorded on the Customer’s statement. Upon notification of the loss or disappearance of any card, W & H agrees to issue the customer a new card with a new pin.

3. Customer agrees to not leave the dispensing equipment unattended at any time while it’s being operated and to accept the responsibility of controlling sources of ignition. The customer agrees to abide by all state fire regulations and also Environmental Protection Agency rulings while utilizing the Cardtrol System.

4. Customer may terminate this agreement at any time by returning all the cards to W & H with payment in full for their charge account.

5. Customer understands that the Pin number is a special 4-digit number which must be manually entered every time the customer purchases fuel. A pin is used for security. Please store your pin separately from your cardtrol card.

The undersigned hereby unconditionally guarantee(s) payment when due, and agrees to pay all expenses (including attorney’s fees and legal expenses incurred by W & H to collect the debt and enforcing this guarantee).

Signature

Date

Optional: Please fill this out if you want a business membership application (recommended.

I/We the undersigned, being eligible for membership in the W & H Cooperative Oil Company of Humboldt, lowa, hereby apply for membership which, upon acceptance, will be acknowledged and duly recorded by the issuance of a certificate for one share of common stock at a total purchase price of $10.00. I/We the undersigned agree to the following:

1. The undersigned has received a copy of the articles of the association.
2. The undersigned may review the most recent annual report of the association at the corporate office in Humboldt.
3. The undersigned agrees to take any applicable patronage refunds into taxable income in the taxable year in which such written notices of allocation are received, in accordance with the by-laws of the association.
4. The undersigned is a person who customarily uses the supplies, commodities, or services of the association.

Enclosed with this application is my one time $10.00 membership fee.

The membership of the association is not transferable, except for repurchase by the association. This application is subject to acceptance by the association and shall be fully effective and irrevocable upon acceptance by the board of directors or the association without written notice by the secretary to the undersigned.

Are you currently actively engaged in farming? (Includes leasing land on a crop share basis, but does not include landlurds that only receive cash rent.)

Signature

Date

Account Number

Please issue membership as follows:
Name

Federal TIN #

Address

City

State

Zip

Business Type

If Corporation, Partnership or LLC is checked and has less than 6 shareholders, please attach the minutes from your board meeting listing al shareholders by percentage of ownership, full legal names, current addresses and social security numbers.

Accepted By Directors on:

Signature:

I represent that the above information is true and is given to induce W & H Cooperative Oil Company to extend credit to the applicant. My company and I hereby authorize W & H Cooperative Oil Company or any credit bureau or other investigative agency employed by W & H Cooperative Oil Company to investigate any reference herein listed or statements or other data obtained from me or from any person pertaining to the company’s credit and financial responsibility.

I UNDERSTAND AND AGREE THAT CREDIT PURCHASES ARE SUBJECT TO A FINANCE CHARGE OF 1.5% PER MONTH, WITH A MINIMUM MONTHLY CHARGE OF $.50 FOR ANY MONTH IN WHICH A FINANCE CHARGE IS IMPOSED. NO FINANCE CHARGE IS IMPOSED IF THE BALANCE AT THE END OF THE MONTH IS PAID BY THE 15TH DAY OF THE FOLLOWING MONTH, AND I HEREBY AGREE TO PAY ANY SUCH CHARGES ASSESSED.

No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department. The undersigned agrees to pay for all costs, attorney fees, and other expenses that W & H Cooperative expends or incurs in the collection of any indebtedness for credit extended under this credit application.

Signature

Date

PERSONAL GUARANTY
The undersigned unconditionally guarantees to W & H Cooperative Oil Company the prompt payment when due of all obligations under this account. The undersigned agrees to pay all attorney's fees and other expenses incurred by W & H Cooperative Oil Company by reason of default. It is understood that this guaranty shall be a continuous and irrevocable guaranty and indemnity for such indebtedness. This guaranty shall bind the heirs, administrators, successors and assigns of the undersigned and may be enforced by or for the benefit of any assignee or successor of W & H Cooperative Oil Company. This guarantee extends to all principal, interest, costs, fees, attorney fees, and expenses incurred upon or by virtue of the extension of credit hereunder.

Guarantor Signature

Date

Business Credit Application

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