Consumer Credit Application
Name
Name
First
Last
Spouse
Spouse
First
Last
Billing Address
Billing Address
City
State/Province
Zip/Postal
Country
Physical Address (if different than billing address)
Physical Address (if different than billing address)
City
State/Province
Zip/Postal
Country
Own or Rent
Employer Address
Employer Address
City
State/Province
Zip/Postal
Country
Closest Relative Address
Closest Relative Address
City
State/Province
Zip/Postal
Country
Propane Appliances (check all the apply)
I undestand: 24 hours notice is required for Kerosene and Fuel Oil orders 3-4 days notice required for LP Gas orders
I authorize Quality Oil & Gas to make whatever inquiries it deems necessary in connection with this credit application and in the course of review or collection of any credit extended in reliance on this application. I further authorize any person or Consumer Reporting Agency to complete and furnish to the Quality Oil & Gas any information it may have obtained in response to such inquiries, and agree that such information, along with this application shall remain the property of Quality Oil & Gas whether or not credit is extended. All information stated in this application is declared to be a true representation of the facts and made for the purpose of obtaining the credit requested. By signing this application, I agree to be bound by the terms and conditions of the Account Terms and Agreement set forth.
I have reviewed and agree with the Account Terms and Agreement listed above.