Residential / Individual Account Applicant (Non Business Account)

ACCOUNT APPLICATION FORM GUIDELINES

Thank you for your interest in setting up an account with Woodford Oil Company!
Date of application

Month Day Year
Date Hour Minutes AM/PM Option

Residential / Individual Account Applicant (Non Business Account)
The product(s) you would like: *

Bulk Fuel Fuel Oil Propane Lubricants Woodford Express Card (Cardlock)
Sales Representative:
Name
First Name *
Last Name *
SOCIAL SECURITY NUMBER
Address
*
Street Address
*
Street Address Line 2
*
City
*
State/Province
*
Postal/Zip Code
PHONE *
MOBILE
WORK
EMAIL *
example@example.com
DATE OF BIRTH *

Month Day Year
Date
EMPLOYER
# OF YEARS EMPLOYED:
Do you: *

Own Rent
Is it a: *

House Mobile Home
Landlord Name *
Phone
Do you own your own tank? *

Yes No
What size?
Would you like Woodford to provide a rent-free tank? *

Yes No
What size?
Comment
PRIVACY DISCLOSURE POLICY: Woodford Oil Company has never shared or sold any of our customer’s personal information. It is our policy to not share any such information in the future. We restrict access to your non-public personal information to employees of Woodford who need to know such information in order to provide products or services to you. We maintain physical, electronic and procedural safeguards that comply with applicable standards to guard your non-public personal information. We collect non-public personal customer information from the following sources: from you on this application or other related forms, from your transactions with us and from third parties such as a consumer reporting agency. We do not disclose any non-public personal customer information about any present or former customers except as may be permitted or required by law. We will provide government agencies the information requested by such agencies if such agencies are authorized by law to receive such information. The information provided to Woodford on this credit application or any other information provided that is required or related to this credit application is for the purpose of applying for credit. The undersigned applicant certifies that all such information is true, correct and complete. Authorization is hereby given to Woodford to check credit/employment records and references. All accounts will be verified by using a credit report supplied by Equifax. If this credit application is approved, the undersigned applicant agrees to make all payments for any products and services provided according to Woodford’s credit terms. Payment is due within 15 days of delivery date. A finance charge of one and one half percent (1.5%) per month or 18% per annum, or the maximum allowable by state law, may be assessed on delinquent invoices.

I/We, the undersigned, hereby agree that in the event of default in the payment of any amount due, Woodford shall have the right, without notice to customer, to declare all invoice amounts due and payable. In the event the account becomes past due and is referred to an outside collection agency or attorney, customer agrees they will be responsible for the collection costs (up to 33% of the balance due), along with reasonable attorney fees and court costs incurred, whether or not suit is filed. Woodford reserves the right to assess legal fees, including attorney and court fees, upon any customer, who by their action or inaction directly or indirectly cause Woodford to be a defendant, codefendant or to have to testify in any civil or criminal legal action or arbitration.
Payment via ACH requires a voided check attached to the application.

Opt-out of Automatic Propane Delivery (will monitor my tank & call in for delivery when tank is at 35%)
How many Woodford Express cards will you need for your account?
Welcome to Woodford Oil Company Voyager Cards. Take advantage of nationally accessible fuel locations throughout the United States. You can assign driver or vehicle names, assign a four digit PIN number and opt for odometer readings. An itemized invoice will be sent with your statement on a semi monthly basis. Please fill out the information below and indicate the options you require.
Card - 1
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 2
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 3
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 4
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 5
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 6
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 7
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 8
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 9
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 10
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 11
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 12
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 13
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 14
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 15
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 16
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 17
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 18
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 19
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 20
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 21
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 22
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 23
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 24
Driver Name
Vehicle #
Odometer

Yes No
PIN
Card - 25
Driver Name
Vehicle #
Odometer

Yes No
PIN
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH Debits)

ACH Authorization Application
I, hereby authorize WOODFORD OIL COMPANY, herein after called COMPANY, to initiate Debit entries to my (our) Checking account indicated below, at the depository named below, hereinafter called DEPOSITORY, to Debit (Withdraw) the same from my (our) account
DEPOSITORY NAME:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
ABA ROUTING NUMBER:
ACCOUNT NUMBER
ACCOUNT NAME:
This authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it
Signature *

Clear
DATE *

Month Day Year
Date
PRINT OR TYPE NAME: *
Please attach a copy of a voided check to assure proper bank information.

Browse Files

Cancel of
Or take a picture of the voided check to assure proper bank information.
ACH Acknowledgments will be sent to email address on the application. Unless otherwise specified below.
Comment Section:
Note: The receiver may revoke the authorization only by notifying the company in writing at P.O. Box 567, Elkins, WV 26241.

SBT
Should be Empty:

ACCOUNT APPLICATION FORM GUIDELINES

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AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS (ACH Debits)