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Credit Application

Become a Shipley Wholesale Fuels Customer!

In this time of extreme market volatility, you may be asked to provide security on your anticipated account balance. This helps us to remain competitive by reducing risk across our entire customer base.

After your credit has been established, you will be asked to sign a Purchasing Agreement, which outlines your credit limit, payment terms, potential finance charges and your guarantee to pay on time. We can begin making deliveries as soon as the Purchasing Agreement is executed and returned.

If you have any questions on the credit approval process, please contact us.

 

Please complete this application in its entirety.  Fields marked with * are required.

Part A: Company Information

Part B: Owner Information and References

Part C: Tax Information

*** If tax exempt you must provide a copy of all tax exempt forms***

Part D: Bank Information

 

Part E:   Estimated Volume

 

Part F:   Product Types

Click the checkbox of only the products you are interested in purchasing and please provide us with the tank size, registration # and expiration.

 

 

Part G:   Signature

 

APPLICANT'S SIGNATURE ATTESTS TO FINANCIAL RESPONSIBILITY, ABILITY, AND WILLINGNESS TO PAY INVOICES IN ACCORDANCE WITH THE ABOVE TERMS.   I HEREBY AUTHORIZE ANY REPRESENTATIVE OF SHIPLEY FUELS MARKETING LLC OR ANY CREDIT BUREAU OR OTHER INVESTIGATIVE AGENCY, EMPLOYED BY SHIPLEY ENERGY COMPANY, TO INVESTIGATE THE REFERENCES HEREIN LISTED OR STATEMENTS OR OTHER DATA OBTAINED FROM ME OR FROM ANY OTHER SOURCE PERTAINING TO MY CREDIT AND FINANCIAL RESPONSIBILITY.

CUSTOMER AGREES TO INDEMNIFY AND SAVE HARMLESS SHIPLEY FUELS MARKETING LLC OF AND FROM ANY AND ALL LIABILITY FOR ANY, LOSS, DAMAGE, INJURY OR OTHER CASUALTY TO THE CUSTOMER OR HIS PROPERTY, OR TO ANY OTHER PERSONS OR ANY OTHER PROPERTY CAUSED OR OCCAISIONED BY REASONS OF ANY LEAKAGE, FIRE, OR EXPLOSION OF NATURAL GAS TRANSPORTED TO OR OILS STORED ON THE CUSTOMERS PROPERTY.


*CUSTOMER AGREES TO PROVIDE A COPY OF MOST RECENT AUDITED FINANCIAL STATEMENT.*
* Required