Credit Application Form / Fuels

Dear Prospective Customer:

Best Line Oil Inc and it's affiliated companies are required by Federal and State law to collect taxes unless you provide with the proper exemption certificates. Please submit copies of all exemption certificates and return with your credit package.

Sincerely,

Best Line Oil, Inc.
CREDIT APPLICATION

Thank you for your business. Our standard credit procedures require that we request the following information in order for us to put you on an open credit system. When credit is confirmed, we may require a deposit equal to one month's charges before the account is opened.
Company Name*
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Mailing Address (leave blank if is the same as Physical Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person*

First NameLast Name
Federal ID#
Tax # (if exempt
Years in Business
Exemption Certificate

Cancelof
Principal Owners (1)
Title
Phone Number
Please enter a valid phone number.
Principal Owners (2)
Title
Phone Number
Please enter a valid phone number.
Accounts Payable email address
example@example.com
TRADE REFRENCES
1) Name*
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Contact*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(2) Name
Phone Number
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Contact
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Customer agrees to Credit Terms; statements due and payable within 10 days of receipt, unless alternative Credit Terms are authorized in writing. Balances outstanding after 30 days are subject to 1.5% per month interest.

Applicant agrees to pay any and all collection costs incurred to collect the account balance including court costs, collection fees and attorney's fees.

As an inducement to grant credit, the undersigned also agrees to the need for verification of all information on this application and authorizes and releases all banks, businesses and persons identified in this application to furnish any and all information requested by Best Line Oil Co. Inc or its affiliated companies. The undersigned authorizes release of such information by the signature below.

I certify that the above information is true and correct. The information is to be used only for the opening of an account, The undersigned for consideration do hereby guarantee collectively the full and immediate payment to Best Line Oil Co Inc or its affiliated companies of all indebtedness heretofore and hereafter incurred for the purchase of materials supplied to the above mentioned company. This guarantee shall not be affected by the amount of credit extended or any change in the form of said indebtedness. This does not revoke the obligation to the guarantors to provide for prompt payment for indebtedness incurred.
Signature*

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Name*
Title
Date

MonthDayYear
Date
In the event of a default in payment by the applicant, corporation or entity, the undersigned personally and unconditionally guarantees payments of all amounts owing to Best Line Oil Con Inc or its affiliated companies as the result of credit extended to the applicant. The amounts to include all reasonable costs of collection, including attorney's fees.
Signature

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Social Security Number
Driver's License Number
CONFIDENTIAL BANK INFORMATION RELEASE FORM
Date

MonthDayYear
Date
BANK*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
FAX Number
Please enter a valid phone number.
Account Number*
The undersigned has entered into an application for credit with Best Line Oil Company and it's affiliated companies. Please consider tis an irrevocable authorization to release information regarding this customer.

All information obtained will be held in strict confidence.

Sincerely,

Best Line Oil Co. Inc.

Twila S. Hensel

Credit Manager
Customer*
DBA*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Signature

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Dyed Diesel Sales. Tax Request
Florida law requires the end user / purchaser of dyed diesel fuel to pay the State Sales Tax and County discretionary sales tax unless the end user is sales tax exempt, (i.e. an agricultural purchaser). End users who owe the tax on dyed diesel must remit the tax on a monthly or quarterly sales tax return OR request the supplier to charge the sales tax and remit the tax to the State on their behalf.

Please indicate below your election regarding the Sales tax and return letter to:

Best Line Oil Co., Inc

219 North 20th Street

Tampa, FL. 33605

Fax: (813) 248-7824

Email: twila.hensel@bestlineoil.com
Yes, charge saales tax on my dyed diesel fuel invoicesNo, do not charge sales tax on my dyed diesel fuel invoices
Company Name
Name
Date

MonthDayYear
Date
Signature

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For our records, please document and attest to your compliance below.

Please return this letter at the following address:

Best Line Oil Co., Inc

219 North 20th Street

Tampa, FL. 33605

You may also fax this form to (813) 284-7824 or email to;

twila.hensel@bestlineoil.com with the subject line noted as "Tank Registration Compliance Letter"

Please take into consideration that according to State and Federal laws all fuel tanks >500 gallons must be registered and have an ID#.

If your tank is <500 gallons, please write the size as the reason why it is NOT required to be registered.
My above ground tank is required to be registered: DEP Facility ID#*
My above ground tank is NOT required to be registered because:*
My underground tank is required to be registered: DEP Facility ID#*
My underground tank is NOT required to be registered because:*
My tank is located in this County:*
Date

MonthDayYear
Date
Customer Name
Title
Please attach W-9

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Signature

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Should be Empty:

CREDIT APPLICATION

TRADE REFRENCES

CONFIDENTIAL BANK INFORMATION RELEASE FORM

Dyed Diesel Sales. Tax Request