Forms

Here are some important forms you will need:

Business Application

Please fill out the required information below to submit a Business Application:

(Click here for a printable version.)

* = required
Applicant Name (name to appear on account) *
Other Business Name(s) or DBA *
Federal Tax I.D. # *
Phone *
Physical Address *
City *
State *
Zip Code *
Date Business Established
Year *
Billing Address *
City *
State *
Zip Code *
Billing Contact *
Phone *
Fax *
Type of Service
(example: Propane
Gas)		 *
Directions To Property:*
County *
Principal's Name *
Title or Position *
Physical Address *
City *
State *
Zip Code *
Social Security # *
Birth Date *
Company Name *
Federal Tax I.D. # *

Company Type

Billing Address		 *
City *
State *
Zip Code *
Accounts Payable Contact *
Credit Limit Requested $ *

(For requests of $5,000 or more the Company's most recent financial statement is required)
Delivery Address
(If different from above)
City
State
Zip Code

Does Company Require A Purchase Order #*
Bank & Trade References
Bank *
Account # *
Address *
City *
State *
Zip Code *
Phone *
Fax *


Trade Reference #1 *
Account # *
Address *
City *
State *
Zip Code *
Phone *
Fax *


Trade Reference #2 *
Account # *
Address *
City *
State *
Zip Code *
Phone *
Fax *


Trade Reference #3 *
Account # *
Address *
City *
State *
Zip Code *
Phone *
Fax *

The above named person or entity (the "Applicant") hereby applies for credit from K.B. Johnson Oil & Gas Company. In connection therewith, Applicant provides the information set herein. The information provided will be utilized by K.B. Johnson Oil & Gas Company for the purpose of processing this application and inquiring into the Applicant, and such information will be kept confidential except in connection with the said purposes.

The undersigned hereby certifies that all of the information provided in this application for credit is true and correct. Furthermore, the credit and collection terms of K.B. Johnson Oil & Gas Company as explained to the undersigned and agreed to, and prompt payment of any indebtedness owned to K.B. Johnson Oil & Gas Company is hereby guaranteed. "Applicant" hereby agrees to pay any legal/collection/court costs associated with this indebtedness.

I agree to these terms


 


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K.B. Johnson Oil & Gas Co. - 1709 North Main Street, Fuquay Varina, NC 27526 - Phone: 919-552-5474
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