Commercial Application

First Name *

Last Name *

Email *

Name of Firm *

Company Phone Number *

Billing Contact *

Billing Contact Phone Number *

Mailing Address *

City *

State *

Zip *

Type of Business *

Years Established *

Is Business Incorporated? *

Yes No

Bank Affiliation *

Loan Officer *

Phone Number *

Billing Documents: Please select one*

Email Documents- I give DOC authorization to set my account up on paperless billing. I understand I will receive billing documents and delivery slips by email only.

Mail Documents - I understand DOC will leave a delivery slip each time a delivery is made. If the delivery slip is priced, this is considered the invoice by which to pay from. If it is not priced, DOC will send a billing document by US mail. If the account is a DOC CARD account only, statements will be sent by US mail.

First Name *

Last Name *

SSN *

Date of Birth *

Home Address *

City *

State *

Zip *

First Name

Last Name

SSN

Date of Birth

Home Address

City

State

Zip

First Name

Last Name

SSN

Date of Birth

Home Address

City

State

Zip

What Products and Services Do You Need?

DOC Card Gasoline Diesel

How Many Cards Do You Need?

North Maine Woods Key: Which Location(s)?

Specify Tank Size(s)

Estimated Monthly Purchases in Dollars

Business Name *

Contact Name *

Address *

City *

State *

Zip *

Phone Number *

Fax

Email

Business Name *

Contact Name *

Address *

City *

State *

Zip *

Phone Number *

Fax

Email

Comments

Sign Application

Everything that I have stated in this application is correct to the best of my knowledge. I understand that Daigle Oil Company will retain this application whether or not it is approved. Daigle Oil is authorized to check my credit and references. If this application is made by a corporation, it is agreed that the person making the application on behalf of the corporation shall be the individual liable for all purchases made pursuant to this agreement.

By checking this box, I acknowledge that I have read the above statements and agree to the terms and conditions *

* Applicant Signature

DOC - Daigle Oil Co.

COMMERCIAL DOC APPLICATION

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