Business Credit Application

Business Information

Business Name*

Type of Operation*

Proprietorship
Partnership
Incorporated

Business Start Date*

Business Type*

Business Address*

Street Address City Province Postal Code

Business Phone*

Business Email Address*

Business Website URL

A/P Contact

A/P Contact Name*

First Last

A/P Contact Phone*

A/P Contact Email Address*

Head Office

Head Office Address*

Same as previous

Street Address City Province Postal Code

Billing

Billing Address*

Same as previous

Street Address City Province Postal Code

Email Statements/Invoices?*

Yes
No

Statements/Invoice Email Address*

Principal

Principal Name*

First Last

Principal Date of Birth*

Principal Residence Address*

Same as previous

Street Address City Province Postal Code

Principal Phone*

Principal Email Address*

Bank Reference

Bank Name*

Bank Branch #*

Bank Address*

Street Address Address Line 2 City Province Postal Code

Trade References

Trade Reference #1 Name*

First Last

Trade Reference #1 Phone*

Trade Reference #1 Email Address

Trade Reference #2 Name

First Last

Trade Reference #2 Phone

Trade Reference #2 Email Address

Products

Products Required*

24 hr. Fuel Access
Bulk Tanks
Furnace Fuel
Keylock
Lubes
Propane

FOBS Required*

FOBS Access*

Select all products you require access to with your FOBS.

Gasoline
Clear Diesel
Dyed Diesel
Vehicle Propane

Fuel and Propane Delivered Bulk

Gasoline
Clear Diesel
Dyed Diesel
Vehicle Propane

Lubricants

Packaged
Bulk

Home Heat

Propane
Furnace Oil

Terms & Conditions

You must agree to the following to submit your application*

The person(s) submitting this form certifies the above information to be true and agrees to pay all accounts upon receipt, and further agrees to guarantee personally the payment of all monies which shall become due to DOWLER-KARN LIMITED from the above name business. The applicant is made with the understanding and agreement that all charges for products, parts, material and labour will be assessed a service charge on all overdue amounts at the rate specified on our invoices.
I am the applicant named herein, and herby authorize DOWLER-KARN LIMITED TO OBTAIN FROM ANY CREDIT STANDING, ALL PERSONAL AND/OR FIRMS CONTACTED FOR SUCH PURPOSE MAY FREEELY GIVE ANY INFORMATION CONCERNING ME AND I HEREBY WAIVE ALL RIGHT OF ACTION FOR ANY CONSEQUENCES RESULTING FROM SUCH INFORMATION.