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| Welcome To Coast Oil Co., LLC- Commercial Fueling |
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Online Account Credit Application Please fill out the following online application to start the credit approval process with Coast Oil Co, LLC/ Pacific Pride. Upon approval you will be asked to sign the enclosed application information and the additional cardlock use terms. OR Download the .pdf version and print, fill out, sign, and fax to 408-255-5263, attention Credit Department
ONLINE APPLICATION IS UNDER CONSTRUCTION. PLEASE CLICK ON "DOWNLOAD CREDIT APPLICATION" TO START CREDIT PROCESS. FAX COMPLETED APPLICATION TO 408-255-5263, ATTENTION CREDIT DEPT. Full Name of Firm Phone Number Fax Number Cellular Number Email Address Mailing Address City State Billing Address City State Type of Ownership: FEDERAL ID NUMBER: How Long in Business? Type of Business: Name and Address of Parent Company ( skip if does not apply): Under what other company names have you operated ( skip if does not apply)?
If in business less than two years please give name, address and length of time of employment for the last five years ( skip if does not apply): Please list the names and titles of partners or corporate officers ( skip if does not apply): Complete Address Phone Number Fax Number Applicant/ Owner/ Officer Name Title Home Phone # Home Address: How Long? (Years) Own Buying Renting Driver's License Number/ State of Issue Social Security Number Date of Birth Have you ever filed bankruptcy? Yes No If answer is Yes: Personally Business When Where REFERENCES: Name of Bank and Branch City State Account Number Phone Number Current Petroleum Supplier ( skip if does not apply) Alternate Supplier Trade Reference Account Number Phone Number
Are you currently using Pacific Pride? Have you used Pacific Pride in the last 9 months? Estimated monthly fuel usage: Gallons: $ Amount Person(s) to contact regarding arrangements for fueling cards: Phone Number Cellular Number Email Address Fax Number Accounts Payable Contact Phone Number
I authorize Coast Oil Co, LLC to request consumer and business credit report for purposes of determining my current and continued credit worthiness. The permissible pirpose(s) for which the report is being obtained certifies the report will not be used for any other purpose. I understand that Coast Oil Co, LLC will be requesting a consumer credit and business report in conjunction with this commercial business application. I release all such persons from any liability or damages that may be incurred as a result of such an inquiry or the furnishing of such information. I certify that the information on this application is true and complete. Additionally, I agree to all additional cardlock use terms. Name of Applicant: Title: Date:
Upon approval you will be asked to sign the enclosed application information and the additional cardlock use terms. Thank you for your interest in Coast Oil Co, LLC and Pacific Pride! |
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Questions or problems regarding this web site
should be directed to melencova@coastoil.com |
