Old Credit Application Form

CONTACT INFORMATION
Name
ADDITIONAL INFORMATION
Delivery Address
Rent or Own?
Automatic Delivery
Furnace Insurance
MM slash DD slash YYYY
AGREEMENT
THE APPLICANT AGREES TO THE ABOVE STATED TERMS AND AGREES TO PAY INTEREST ON ALL INVOICES EXCEEDING OUR TERMS OF SALES WHICH ARE SUBJECT TO A 2% INTEREST CHARGE PER MONTH (24% PANNUM). I ACCEPT YOUR OFFER TO SUPPLY MY ENTIRE REQUIREMENTS OF HOME HEATING OIL AND AGREE TO MAKE PAYMENT WITHIN THE TERMS OF OUR CONTRACT. I ALSO AGREE THAT GREEN COAST ENERGY MAY OBTAIN A CONSUMER CREDIT REPORT FROM A REPORTING AGENCY AND MAY EXCHANGE SUCH CREDIT INFORMATION. GREEN COAST ENERGY RESERVES THE RIGHT TO LIMIT OR WITHDRAW CREDIT AT ANY TIME ITS DISCRETION AND TO ALTER THE RATE OF CREDIT PAYABLE ON UNPAID BALANCES.