APPLICATION FOR CREDIT

by:

Name of Firm or Individual:

Phone:

Address:

Years At This Address:

City:

State:

Zip:

HEREBY applies for credit in accordance with the terms and condition of:

to:

CHESHIRE OIL COMPANY, Inc., PO Box 586, Keene, NH 03431

Credit Manager: Jean Wright

Phone: 603-352-0001

ownership:

Please list the names, addresses, and phone numbers of principals:
.

___ Corporation ___Check here if incorporated within the past 12 months ___Partnership ___Individual

The following information must be provided. It will be held in strictest confidence.

1.

2.

3.

finance:

Bank:

Bank Address:

Phone:

Bank Officer or Department:

references:

Names, addresses and phone numbers of references:

1.

2.

3.

4.

.

We certify that all the information on this form is correct.
We fully understand your credit terms and agree to the proper payment in consideration of extended credit.

Signed:

Title:

verification:

References checked by:

___Credit Approved by:

Reference results:

___Credit Refused by:

.

Date: