Apply For Credit - Gordon Oil

"*" indicates required fields

1Service Info

2Applicant Info

3Final Info

BUSINESS INFORMATION
Customer Name*

DBA

Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name*

Phone*
Fax
Federal Tax ID*

Principle Officer/Partner 1*

Title*

Social Security#*

Principle Officer/Partner 2

Title

Social Security#

Bank References
Bank Name/Branch*

Account #*

Contact*

Phone*
Fax
Trade References
Oil Suppliers
Name*

Contact*

Phone*
Address
Street Address Address Line 2 City State ZIP Code

OTHER TRADE
Name*

Contact*

Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name*

Contact*

Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Delivery/Service Information
(All credit approved propane accounts will be set up on automatic delivery)
Consent*
I agree with the below
*Please note that if multiple locations are being serviced by MX Petroleum Corp. this agreement will be used as a blanket agreement to cover all propane tanks in use by the customer at all locations served by MX Petroleum Corp.
Delivery Address*
Street Address Address Line 2 City State ZIP Code

Select one*

Own

Rent

Temporary Jobsite

Other

If location is rented or temporary jobsite: Name of Property Owner/Landlord*

Account # if applicable

Account # if applicable

Landlord Phone*
Landlord Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

MX PETROLEUM CORP. GENERAL TERMS AND CONDITIONS*
I agree to the below.
Where possible, BUYER shall agree to MX Petroleum Corp.’s (Herein referred to as SELLER) Standard Agreement prior to delivery of product from seller’s truck.

TITLE: Title and risk of loss, including without limitation, risk of damage, deterioration and/or evaporation, passes from seller to BUYER when the product passes the flange or spout between SELLER’S delivery line and BUYER’S receiving connection or equipment. Whether truck, rail car, barge or other receiving equipment.

CREDIT: SELLER will issue a credit limit at its discretion after receiving and examining references and other which may be requested for the purpose of establishing credit limits. SELLER reserves the right at any time to withdraw or adjust the credit limit. If required by SELLER, the BUYER will issue security in a form and amount acceptable to the SELLER or provide a Personal Guaranty.

PAYMENTS: Credit terms of payment will be set upon completion and review of this application and will be subject to credit limits assigned. To the extent that purchases remain unpaid beyond agreed terms; SELLER will assess finance charges or interest, whichever is applicable, at the maximum rate allowable under State Law. Payments received will be applied to any finance charges or interest owing on the account first, with any remaining credit to be applied towards the aging balance.

If payment is not received within the allotted terms, SELLER the right to revoke charge status. If full restitution is not made on purchases within 60 days and no other payment agreement can be reached, SELLER reserves the right to charge any credit card on file or perform an E.F. T. payment using BUYER’S bank information to secure the balance past due on your account. If this option is not available, SELLER also reserves the right to proceed with collections through a 3rd party agency or take civil action against BUYER in a court of law. Any expense accrued by SELLER while attempting to collect a debt owed, including but not limited to reasonable attorney’s fees and court costs, must be reimbursed to SELLER by you the BUYER.

TAXES: All taxes, duties, fees or any other charges (collectively “Taxes”) that are imposed or assessed by any Federal, State, County or Local Government or Agency in respect to the purchased product will be paid to the SELLER by the BUYER. If BUYER is exempt from any taxes, fees or charges, it must provide the Seller with a proper Exemption Certificate prior to lifting any product. Failure to timely provide the proper Exemption Certificate shall automatically subject the BUYER to pay such tax, fee or charge, include any applicable interest, penalties, and/or consequential costs or fees imposed upon Seller as a result of such failure.

FORCE MAJEURE: Neither the SELLER nor BUYER is liable for failure to timely perform any of his obligation under this contract, if failure was due to impediment beyond the party’s control, including but not limited to National and International markets in fuel supply and production. The party-claiming impediment shall give facsimile notice to the other party prior to delivery time and date. The party-claiming impediment shall use all reasonable and diligent efforts and delivery shall be suspended only so long as the impediment remains, unless the parties agree to terminate their mutual obligation.

MX PETROLEUM CORP. GENERAL TERMS AND CONDITIONS*
I agree to the below.
CLAIMS: Any controversy or claim regarding the quality of purchased product will be Time-Barred unless by the BUYER in writing to the Seller within ten (10) days of purchase date.

ASSIGNMENT: The BUYER cannot assign any of its product contract rights or obligations without the prior written consent of the SELLER. Seller may assign the product contract rights for the purpose of financing to its banks and/or financial institutions.

WAIVER: Any failure of the SELLER to enforce any provision shall not be deemed a waiver of the right to enforce such provisions in the future.

WARRANTY: Except as to quality, SELLER makes no warranties, expressed or implied, with respect to the merchantability of product or otherwise. The warranty of fitness for a particular purpose is expressly disclaimed. In no event shall Seller be liable for incidental, consequential or punitive damages.
PRIMARY APPLICANT INFORMATION
Name*
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code

Site Address (if different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

# of Years at This Address*

Phone*
Email*

Do you wish to receive invoices via email?*
Do you wish to receive statements via email?*
Social Security #*

Date of Birth*
Month
Day
Year

Drivers License #*

Drivers License State*

Drivers License Expiration Date*
Month
Day
Year

I am

Retired

On Disability
Employer*

Years at Employer*

Work Phone
Work Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is there a Co Applicant?*

Yes

No
CO APPLICANT
Co Applicant Name*
First Last
Co Applicant Social Security #*

Co Applicant Date of Birth*
Month
Day
Year

Co Applicant Drivers License #*

Co Applicant Drivers License State*

Co Applicant Drivers License Expiration Date*
Month
Day
Year

Select if Co Applicant is

Retired

On Disability
Co Applicant Employer*

Co Applicant Years at Employer*

Co Applicant Work Phone*
Co Applicant Work Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

BANK INFORMATION
Bank Name*

Bank Account #*

MORE INFORMATION
Bank Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Directions to Site Address*
Tank Size

Tank Location*
Do you heat your hot water with oil?*
Do you heat with an alternate heat source?*
What do you heat with*

If credit approved, do you wish to be on automatic delivery?*
Additional Notes
Agree to Terms of Payment?*
Yes, I Agree
General Terms & Conditions*
I agree to the below General Terms & Conditions
TERMS OF PAYMENT Credit terms are net ten (10) days from delivery, subject to credit limits assigned by MX Fuels, A Division of MX Petroleum Corp. To the extent that purchases remain unpaid beyond agreed terms, buyer will lose credit privileges and any special prices or discounts in place between seller and buyer, and seller will assess late payment charges or interest, whichever is applicable, at the maximum rate allowable under state law. Buyer agrees to reimburse seller for all collection expenses, including reasonable attorney fees incurred in connection with the collection of delinquent amounts. By checking below, I confirm that the information I have given in this application is complete and accurate. I authorize MX Fuels to verify this information, and I authorize the release of personal information listed above, solely for the use of credit verification by MX Fuels. I agree to the MX Fuels Terms of Payment.
Phone
This field is for validation purposes and should be left unchanged.

Notice

Due to the high demand for propane, we are unable to accept any new generator only propane customers at this time.

If you wish to contact us with questions, please feel free to contact us at 1-800-840-0645.

If location is rented

PROPANE EQUIPMENT REQUIRED

BUSINESS INFORMATION

Bank References

Trade References

Oil Suppliers

OTHER TRADE

Delivery/Service Information

PRIMARY APPLICANT INFORMATION

CO APPLICANT

BANK INFORMATION

MORE INFORMATION

MX MASSENA

MX WESTVILLE

GORDON OIL AUSABLE FORKS

HOMENERGY