Buckley Oil

Credit Application

Type of Business	Sole Owner Partnership Corporation
Tax Status
Sales Tax	Sole Owner Partnership
Dyed Diesel / Dyed Kerosene	Sole Owner Partnership

Purchase Order Required	Yes No

*NOTE: If applicable, Customer must furnish Buckley Oil with a Resale / Exemption Certificate form and/or appropriate State End User / Exemption Certificate.*

(Trade references only. No Banks, please)
Referance 1
Company Name
Address
Phone No.
Email / FAX
Referance 2
Company Name
Address
Phone No.
Email / FAX
Referance 3
Company Name
Address
Phone No.
Email / FAX

I hereby agree to pay within invoice terms, in return for the extension of credit. Also, should it be necessary for Buckley Oil Company to utilize an outside Collection Agency for past due balances I will be liable for the collection fees accessed.
Officer
Title
Date