Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Delivery Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business Main Phone *

(###)

###

####

Business Type *

Proprietorship

Partnership

Corporation

Government

LLC or LLP

Individual

Accounting Contact Name *

First Name

Last Name

Accounting Contact Phone *

(###)

###

####

Purchase order required *

Yes

No

Is account sales tax exempt? *

Yes - email certificate to accounting@snyder-green.com

No

Preferred Contact Method *

Phone

Email

Signature *

Applicant certifies that all information contained herein is true and correct and grants permission to Green Brothers of Seattle dba Snyder-Green Oil to obtain independent credit reports or other information from the listed references and bank, and authorizes the credit references and the bank reference to release information to Snyder-Green that may be used to determine credit worthiness. Signer certifies that they are authorized by the company to sign on the behalf of the company for this application. Payment Terms are: Net 30 for commercial deliveries under $2,500 and Net 10 for commercial deliveries over $2,500 Applicant agrees to pay all bills as rendered, and understands and agrees that overdue accounts may be subject to monthly service charges equal to 1% per month. Applicant agrees to pay all reasonable costs of collection, including actual out-of-pocket expenses and applicable collection fees through a collection agency and/or attorney. The laws of Washington shall govern all contracts entered into between Applicant and Snyder-Green Oil and all disputes may be resolved within the Courts of that State.

First Name

Last Name

Direct Phone Number *

(###)

###

####

Name *

First Name

Last Name

Home Phone *

(###)

###

####

Cell Phone *

(###)

###

####

Work Phone *

(###)

###

####

Delivery Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Own or rent? *

Own

Rent - If Rent fill out Rental Property info below

Rental Property Phone

(###)

###

####

I use heating for: *

Home heating only

Water heating only

Home and water

Pool only

Home and Pool

Home, Water and Pool

Do you have Pets outside? *

No

Yes - They are friendly

Yes - They need to come inside before delivery - Please call me

Additional Name on Account

First Name

Last Name

Additinal Name Cell Phone

(###)

###

####

Are you wanting a delivery at this time? *

No

Yes

Signature *

By Typing your name below you are agreeing to all terms and conditions as listed below. Applicant certifies that all information contained herein is true and correct and grants permission to Green Brothers of Seattle dba Snyder-Green Oil to obtain independent credit reports that may be used to determine credit worthiness. Payment Terms are: 1st delivery is COD after that account moves to Net 10th (Due on the 10th of the month after the delivery). Applicant agrees to pay all bills as rendered, and understands and agrees that overdue accounts may be subject to monthly service charges equal to 1% per month. Applicant agrees to pay all reasonable costs of collection, including actual out-of-pocket expenses and applicable collection fees through a collection agency and/or attorney. The laws of Washington shall govern all contracts entered into between Applicant and Snyder-Green Oil and all disputes may be resolved within the Courts of that State. Fees: Fees are subject to change and can change at any time. Emergency deliveries are $50.00. Nights and weekend deliveries are $150.00. Return check/credit card are $50.00. Deliveries under 100 gallons are $50.00. Mis-order fee of $1 per gallon under 150 gallons. Attempted delivery fees are $100.00. Pet Fecies clean up of hose $150.00. Other fees may be charged depending on circumstances. The customer is responsible for keeping their delivery area and access clear of debree, fecies, trees, bushes, snow, ice and other items. If we are unable to deliver because of hazardous conditions, we will call the customer once, and then come back. Additional returns after that one become billable charges.

First Name

Last Name