R. K. ALLEN OIL COMPANY, INC
Pensacola Talladega
Opelika
723 W Main Street
P. O.
Drawer 456
1708 Columbus Parkway
Pensacola, FL 35202
503 E Battle
Street
Opelika, Alabama 36801
Talladega, Alabama 35161
(850)433-6515
(256)362-4261
(334)741-0360
(850)435-7802 Fax (256)362-6792
Fax
(334)741-0360 Fax
NEW
CUSTOMER APPLICATION
COMPANY NAME:____________________________________________________________
COMPANY ADDRESS:_________________________________________________________
PHONE #________________________ FAX#________________________________
FEDERAL ID#_____________________ STATE ID #_________________________
ACCOUNTS PAYABLE CONTACT:______________________________________________
D&B #______________________________ COUNTY_________________________________
ARE YOU A MOTOR FUEL LICENSE HOLDER?_ ________, IF YES PLEASE LIST STATES AND LICENSE NUMBERS
_________________________________________________________________________
ARE YOU A LUBRICANT LICENSE HOLDER?________, IF YES, PLEASE LIST
STATES AND LICENSE NUMBERS
________________________________________________________________________
CORPORATE OR PJ CITY TAX RATE_____________. COUNTY TAX RATE___________________
ARE YOU TAXED AT ANY SPECIAL RATE________, IF YES WHAT RATE___________
ARE YOU EXEMPT FROM ANY TAX?___________, IF YES PLEASE ATTACH AN EXEMPTION CERTIFICATE.
BANK REFERENCES
NAME
ADDRESS
PHONE #
CONTACT
____________________________________________________________________________________________
____________________________________________________________________________________________
TRADE REFERENCES
COMPAANY NAME
PHONE #
CONTACT PERSONS
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
MUST HAVE THREE REFERENCES
** I THE
UNDERSIGNED HEREBY AUTHORIZES R. K. ALLEN OIL COMPANY, INC. TO INVESTIGATE THE CREDIT HISTORY ON THE ABOVE COMPANY.
** SIGNATURE
MUST BE AN AUTHORIZED REPRESENTATIVE OF THE COMPANY.
__________________________________________ ____________________________________
AUTHORIZED SIGNATURE
Any and all fees, legal or otherwise incurred by R K Allen Oil, Co., Inc. in collection
of any amount due or owing pursuant to this agreement shall be the full responsiblity of the debtors.
