WSO Credit App

Credit Application
BUSINESS INFORMATION
The undersigned (“Customer”) states that all of the foregoing information is true and correct and requests that Western States Oil extend credit, and/or continue previously extended credit, to Customer, in material reliance upon such information. The undersigned provides authorization to release any information necessary toward the processing of an account application with Western States Oil. This information will be kept strictly confidential. The undersigned has read and agrees to the Terms and Conditions (and Additional Cardlock Terms and Conditions if applicable) attached to this agreement and agrees that all of these Terms and Conditions are binding on the Customers. Facsimile and scanned signatures shall have the same force and effect as an original signature.
Authorized Customer Representative*

First NameLast Name
Date*

MonthDayYear
Date
Sales Representative*
Federal ID#*
Legal Name of Company*
DBA*
Years in Business*
Phone*

Area CodePhone Number
Fax

Area CodePhone Number
Email*
example@example.com
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

BUSINESS BANK INFORMATION
Primary Bank*
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank Contact Name*

First NameLast Name
Bank Contact Phone Number*

Area CodePhone Number
Bank Contact Fax*

Area CodePhone Number
Account Type and Number*

CREDIT REFERENCES
Business Name - Reference 1*
Business Address - Reference 1 *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number - Reference 1 *

Area CodePhone Number
Business Fax - Reference 1 *

Area CodePhone Number
Business Name - Reference 2*
Business Address - Reference 2*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number - Reference 2 *

Area CodePhone Number
Business Fax - Reference 2 *

Area CodePhone Number
Business Name - Reference 3*
Business Address - Reference 3*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number - Reference 3 *

Area CodePhone Number
Business Fax - Reference 3 *

Area CodePhone Number

OWNER, PRINCIPAL, AND/OR OFFICER OF THE CUSTOMER
Name - Applicant 1*

First NameLast Name
Position - Applicant 1*
SSN# - Applicant 1*
Home Address - Applicant 1*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Select One - Applicant 1*

OwnRent
Home Phone Number - Applicant 1*

Area CodePhone Number
Driver's License # - Applicant 1*
Date of Birth - Applicant 1*

MonthDayYear
Date
Personal Net Worth - Applicant 1*
Have you ever filed for bankruptcy? - Applicant 1*

yesno
I certify that the information is true and correct. As a principal of the applicant, I authorize and request Western States Oil to obtain and consider my personalcredit in conjunction with this application. Facsimile and scanned signatures shall have the same force and effect as an original signature.*

I agree
Applicant 1 Signature*

Powered by Jotform Sign Clear

Name - Applicant 2

First NameLast Name
Position - Applicant 2
SSN# - Applicant 2
Home Address - Applicant 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Select One - Applicant 2

OwnRent
Home Phone Number - Applicant 2

Area CodePhone Number
Driver's License # - Applicant 2
Date of Birth - Applicant 2

MonthDayYear
Date
Personal Net Worth - Applicant 2
Have you ever filed for bankruptcy? - Applicant 2

yesno
I certify that the information is true and correct. As a principal of the applicant, I authorize and request Western States Oil to obtain and consider my personalcredit in conjunction with this application. Facsimile and scanned signatures shall have the same force and effect as an original signature.

I agree
Applicant 2 Signature

Powered by Jotform Sign Clear
Western State Oils Credit manager, Date
Sales Person Name & Code

TERMS AND CONDITIONS APPLICABLE TO ALL CUSTOMERS
The entity or individual applicant (hereinafter “Customer”) agrees to pay all charges when due. In the event said charges are not timely paid, Customer agrees to pay Western States Oil a service charge of 2% per month on the unpaid balance for all charges not paid within the due date (or the highest rate allowed by law). This is not interest on a loan or a finance charge but an agreed to service charge for the failure to timely pay for goods and services received.

Customer agrees to assume full responsibility for all purchases made on Customer’s account and to pay all bills when due. Customer agrees not to exceed the credit limits set by Western States Oil, however in the event Western States Oil does extend additional credit to Customer, Customer will be deemed to have actual knowledge of such additional credit purchases, and in the event such credit exceeds any such limits, Customer agrees to assume full responsibility and to pay any additional amounts that exceed the credit limit previously set by Western States Oil.

To secure the payment, Customer grants Western States Oil a purchase money security interest in the products sold under this agreement whether constituting goods, payment intangibles and/or general intangibles, including all accessions to and replacements thereof, and all proceeds of the foregoing. Customer authorizes Western States Oil to file one or more financing statements signed only by Western States Oil without customer signature and to use a copy of this agreement as any exhibit to any financing statement. Customer shall execute any additional documents, instruments, financing statements or amendments to perfect or continue the security interest created by this agreement. Western States Oil shall have all of the rights and remedies of a secured party under the Uniform Commercial Code in effect in the state where they reside from time to time, which remedies shall be cumulative and not exclusive.

Western States Oil may, at their option, refuse to permit charges to be incurred on the account. Delivery of product to the facilities or trucks of Customer may be made without obtaining signatures upon delivery. Delivery times are “best efforts” only. Western States Oil will not be responsible for any claims or damages whatsoever for failure to deliver at certain times. Customer and the undersigned certify that the delivery location is unbranded and will immediately notify Western States Oil of any change in writing by certified mail.

The parties agree that, if the account is referred for collection to an attorney, the Customer and the undersigned will pay reasonable attorney’s fees and costs of collection. The parties agree, notwithstanding applicable conflict laws, that the laws of the State of California shall apply to interpretation and enforcement of the terms and conditions set forth herein, as well as any other dispute arising out of this agreement, whether based in contract, tort, statute or otherwise. The parties further agree that, if any litigation is commenced to arising out of this agreement, the sole and exclusive venue for resolution of these disputes will be in Santa Clara County California, in either the California Superior Courts for the County of Santa Clara or the U. S. District Courts for the Central District of California.

Customer and undersigned guarantor further agree that they will irrevocably submit to the jurisdiction of this selected venue, which selection is intended to be mandatory, and waive all right to seek venue elsewhere. The parties further covenant and agree, if suit or litigation is filed by either party to this agreement, California retains both in rem and in personam jurisdiction over both parties and their assets.

To the maximum extent permitted by the applicable law, Western States Oils total aggregate liability to Customer for any claim arising out of or in connection with this agreement for breach of contract, breach of warranty, breach of statutory duty or negligence or other tort, whether by virtue of strict liability or otherwise, will not exceed the invoice value of the relevant delivery of Product, if delivered, or if the above breach of Agreement consists of a failure to deliver, the invoice value of the Product had it been delivered and invoiced. TO THE MAXIMUM EXTENT PERMITTED BY THE APPLICABLE LAW, NEITHER PARTY WILL BE LIABLE TO THE OTHER PARTY FOR LOSS OF PRODUCTION, LOSS OF USE, BUSINESS INTERRUPTION, LOSS OF PROFIT, LOSS OF BUSINESS, LOSS OF GOODWILL OR REPUTATION, OR WASTED EXPENDITURE OR FOR ANY INCIDENTAL, INDIRECT, SPECIAL, CONSEQUENTIAL, OR PUNITIVE COST, EXPENSE, LOSS OR DAMAGE OF ANY KIND.
Applicant 1 Initial here*
Applicant 2 Initial here

CONTINUING PERSONAL GUARANTY
As a direct and material inducement to one or all of Western States Oil companies to grant financial accommodations or otherwise extend credit to Customer, the undersigned (jointly and severally) hereby unconditionally personally guarantees to Western States Oil the payment, when due, of every claim (including but not limited to service charges, reasonable attorneys’ fees and costs) of Western States Oil against the Customer. This is a continuing guaranty and shall remain in full force until written revocation from the undersigned is actually received by Western States Oil , but such revocation shall be effective only as to claims of Western States Oil that arise out of transactions entered into after its receipt of such notice. Western States Oil shall not be required to first proceed against applicant or enforce any other remedy before proceeding against either of the undersigned. As a continuing guaranty, this shall not be discharged by the death of the undersigned and shall bind the heirs, administrators, representatives and assigns and may be enforced by or for the benefit of any successor assignee of Western States Oil. The term of this guaranty shall be for the duration of the agreement, and any addendum thereto, and shall guarantee all obligations that may arise or occur during the term thereof though enforcement shall be sought subsequent to any termination. Notwithstanding the full payment of any claim or receipt of any revocation, this guaranty shall remain in full force and effect or be reinstated with respect to claims against the Customer if the Customer files for bankruptcy protection, or in any court proceeding an order or judgment is entered compelling Western States Oil to return or refund any amount of payment made with respect to the claims. Further, the undersigned agrees to and hereby does, waive any and all right to subrogation against the Customer for monies paid to Western States Oil under this or any other agreement binding the undersigned or the Customer. The undersigned waives all statutory rights available to them as sureties. The undersigned further agrees to pay all reasonable costs, expenses and attorneys fees incurred in the enforcement of this continuing guaranty, or in the enforcement of any obligation as a result of the extension of credit. Facsimile and scanned signatures shall have the same force and effect as an original signature.
Signature of Applicant 1

Powered by Jotform Sign Clear
Name - Applicant 1

First NameLast Name
Signature of Applicant 2

Powered by Jotform Sign Clear
Name - Applicant 2

First NameLast Name
Should be Empty:

Now create your own Jotform - It's free!Create your own Jotform

BUSINESS INFORMATION

BUSINESS BANK INFORMATION

CREDIT REFERENCES

OWNER, PRINCIPAL, AND/OR OFFICER OF THE CUSTOMER

TERMS AND CONDITIONS APPLICABLE TO ALL CUSTOMERS

CONTINUING PERSONAL GUARANTY