Personal Credit Application Applicant InformationName* First Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address City Province Select ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Phone*CellEmail Address* Would you like your statements emailed to address entered above?*YesNoDo you OWN the Property at the address entered above?*YesNoPosession Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Do you RENT the Property at the address entered above?*YesNoLandlord Name* First Last EmploymentEmployer Name*Occupation*Co-ApplicantName First Last Date of Birth ProductsIndicate Products Required* 24 Hr. Fuel Access Diesel Furnace Oil Gas Motor Oils Propane Vehicle Propane FOBS RequiredFOBS 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 Lubricants Packaged Bulk Home Heat Propane Furnace Oil Delivery AddressDelivery Address* Same as applicant address entered above. Street Address City Province Enter ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code You Will Be Serviced Out of Which Dowler-Karn Branch? (if known)St. ThomasSarniaChathamWindsorSt. MarysTillsonburgUnknownCredit TermsYou must agree to the following to submit an application* I, the applicant, wish to open a charge account and charge to said account all goods and services supplied by you, or signed by me. This 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 HEREBY AUTHORIZE DOWLER-KARN LIMITED TO OBTAIN FROM ANY CREDIT STANDING, ALL PERSONAL AND/OR FIRMS CONTACTED FOR SUCH PURPOSE MAY FREELY GIVE ANY REQUESTED INFORMATON CONCERNING ME AND I HEREBY WAIVE ALL RIGHT OF ACTION FOR ANY CONSEQUENCES RESULTING FROM SUCH INFORMATION. Jack & Joyce Karn Collection Featuring More Than 10,000 Items at The Dowler-Karn Museum in St Thomas. Learn More In the Community Supporting Local Events & Communities Across Southwestern Ontario Learn More