Sales Tax Exempt Form Job Application Gas Card Requisition Heating Oil Agreement Credit Application

GAS CARD REQUISITION

 
Account Number
First Name (required)
Last Name (required)
Address
City
Province
Postal Code
Total Number of cards
Delivery Address
City
Province
Postal Code
Contact Name
Phone
Phone
Other
For Office Use Only
Status
Comments
Additional Card Details (Individual Names) Unit# Plate #

The above mentioned company/individual agrees to be responsible for all purchases and safe keeping of all cards issued to them. This card is the property of W.O. Stinson & Son Ltd. and may be cancelled or recalled at anytime. In the case of loss or theft, such responsability shall cease upon the notification to W.O. Stinson & Son Ltd. W.O. Stinson & Son Ltd. will not be responsible for the wrong product being dispensed after normal hours when the site is unattended and fueling is performed by the customer drivers, or operators.

 

Net 30 days, 2% per month (26.82% per annum) on overdue amount.

We certify that the above information is true and accurate and we authorize you to verify our credit worthiness in any reasonable manner you deem appropriate.