Personal Credit Application

Applicant Information

Name*

First Last

Date of Birth*

Address*

Street Address City Province Postal Code

Phone*

Cell

Email Address*

Would you like your statements emailed to address entered above?*

Do you OWN the Property at the address entered above?*

Posession Date*

Do you RENT the Property at the address entered above?*

Landlord Name*

First Last

Employer Name*

Occupation*

Name

First Last

Date of Birth

Indicate Products Required*

FOBS Required

FOBS Access*

Select all products you require access to with your FOBS.

Fuel and Propane Delivered Bulk

Lubricants

Home Heat

Delivery Address*

Same as applicant address entered above.

Street Address City Province Postal Code

You Will Be Serviced Out of Which Dowler-Karn Branch? (if known)

You 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.