CREDIT APPLICATION & AGREEMENT
Please complete the following information and fax to (910) 862-8423 or mail to: Campbell Oil Company,
PO Box 637 Elizabethtown, NC 28337, Attn: Credit Dept.
Company Name:______Tax ID #:______Tax Exempt #______
Owner/s or Officers of Company:______Title:______SS #:______
Company Status:Incorporated_____Limited Liability Company___Partnership_____Sole Owner______
Billing Address:______City:______State:______Zip______
Phone: (_____)______Fax# (_____)______E-Mail Address:______
Accounts Payable Contact (If Different Than Above):______
Products You Wish To Purchase (Circle All That Apply):Regular UnleadedPlus UnleadedPremium Unleaded
DieselOther Products______
Delivery Address:______City:______State:______Zip:______
Contact Name:______Phone: (_____)______
Does Your Company Require a Purchase Order #?______YES______NO
Current Fuel Provider:______Current Payment Terms (i.e. Net 5 Days)______
Credit Limit Requested From Campbell Oil Company: $______
Choose ONE of the following Options:
☐Option 1: My plan is to purchase BRANDED (i.e. Sunoco, Marathon, etc.) fuel from Campbell Oil Company which requires me to sign a long term agreement with conditions and requirements to be established with a Campbell Oil Company Representative
☐Option 2: My plan is to purchase UNBRANDED fuel from Campbell Oil Company
(If you select this plan you must select one of the following options)
☐I will give Campbell Oil Company a certified funds deposit for a minimum amount of 50% of the credit limit requested above. Deposit amount is determined solely by Campbell Oil Company based on customer’s credit, references, and credit limit requested.
☐I will sign a fuel agreement with Campbell Oil Company, and agree for Campbell Oil Company to collect all credit card monies received at store locations to net against fuel purchases.
☐I will wire funds to Campbell Oil Company’s account prior to each fuel purchase.
Bank & Trade References
(Please provide at least one Fuel or Lubricant Co. provider as a reference)
Bank:______Account #:______
Address:______
City:______State:______Zip Code:______
Contact Name:______Phone: (_____)______
Fax: (_____)______Email Address:______
Trade Reference #1:______Account #:______
Address:______
City:______State:______Zip Code:______
Contact Name:______Phone: (_____)______
Fax: (_____)______Email Address:______
Trade Reference #2:______Account #:______
Address:______
City:______State:______Zip Code:______
Contact Name:______Phone: (_____)______
Fax: (_____)______Email Address:______
Trade Reference #3:______Account #:______
Address:______
City:______State:______Zip Code:______
Contact Name:______Phone: (_____)______
Fax: (_____)______Email Address:______
By signing below, I acknowledge and state that I am an authorized representative of the company; and I am giving CAMPBELL OIL COMPANY permission to request credit information from the above bank and trade references; and I understand that a credit check will be conducted on the company &/or owner of company.
Signature:______Date:______
Printed Name:______Title:______
Sales Agreement
The undersigned in consideration for the terms of the sale stated herein for the extension of credit by Campbell Oil Company hereby agree to the terms and conditions of this agreement. It is also understood that any amount not paid within the agreed upon terms will be considered past due, and further, that a 1 ½% service charge (18.0% per annum) will be added to any past due amount. In the event of default in payment, and if the same is placed in the hands of an attorney for collection, the undersigned agrees to pay all costs of collections, including reasonable attorney’s fees. The undersigned expressly agrees that regardless of the place of payment or individual residence, all suits at law or in equity of any breach of this agreement or for the default in payment shall be instituted and maintained in any of competent jurisdiction in Bladen County, North Carolina. The undersigned agrees that any change in ownership or offers of the form that the business operates shall be made known to Campbell Oil Company within three (3) business days. This notice shall be in writing and certified, U.S. mailed to Campbell Oil Company, P.O. Box 637, Elizabethtown, NC 28337.
By signing below, I acknowledge and state that I have read and agree to the terms of this Sales Agreement.
Signature:______Date:______
Printed Name:______Title:______
Personal Guaranty
The party signing this agreement as well as the named Applicant agrees to be personally and unconditionally liable for all charges. The guarantor further agrees to notify Campbell Oil Company in writing within ten (10)calendar days of the receipt of the invoice of any discrepancies or errors in the billing of any fuel and/or merchandise. Failure to notify Campbell Oil Company signifies acceptance of and responsibility for prompt payment in full on the account.
This is intended to be, and shall be construed to be, a continuing Guaranty applying to all sales made by you to the aforesaid, and shall not be revoked by the death of the Guarantor(s) but shall remain in force and effect until I/we or my/our Executors or Administrators shall have given notice in writing to make no further advances on the security of this Guaranty, and until such notice shall have been received by you.
Guarantor waives notice and presentment under the terms of this guaranty. Guarantor agrees to pay Campbell Oil Company’s reasonable attorney’s fees and cost of any litigation that arises out of this application or guaranty.
By signing below, I acknowledge and state that I have read and agree to the terms of this Personal Guaranty.
Signature:______Date:______
Printed Name:______Title:______
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