Hough Petroleum :: Dealer Credit Application
340 4th Street
Ewing, NJ 08638-2750
800-400-7154
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Dealer Credit Application
FORM VOID UNLESS COMPLETE INFORMATION IS SUPPLIED
Thank you
Please correct the following errors:
Business Name
Street Address
City
State
Zip
FED ID #
Phone #
Fax #
Type of Business
Years in business
Own Building?
Own
Rent
Landlord
Landlord Phone #
Principal's Name
Social Security #
Residence Address
City
State
Zip
Principal's Name
Social Security #
Residence Address
City
State
Zip
Bank References
Bank Name
Bank Address
Bank Telephone #
Checking Account
Savings Account
We authorize you to release information concerning the noted account(s) with your bank/company to Hough Petroleum for the purpose of credit verification.
The undersigned individual(s) who is either a principal of the credit applicant, or a sole propriertorship of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report on the undersigned by the above named business credit grantor, from time to time as may be needed, in the credit evaluation process.
Digital Signature 1 (pending confirmation)
Date
Digital Signature 2 (pending confirmation)
Date
Credit References
Name
Phone #
Address
Fax #
Name
Phone #
Address
Fax #
Name
Phone #
Address
Fax #
Customer Survey - Please Complete
How did you hear about Hough Petroleum?
Personal Financial Statement
ASSETS
Checking Account
Bank Name
Bank Address
Bank Telephone Number
Account Number
Savings/Money Market Account
Bank Name
Bank Address
Bank Telephone Number
Account Number
Securities (Current Market)
Tools & Equipment
Real Estate
LIABILITIES
Unsecured Notes (Name, Address and Telephone Number)
Unsecured Note 1
Unsecured Note 2
Contracts & Secured Loans Payable
Contract/Loans Payable 1
Contract/Loans Payable 2
Open Accounts Payable
Name
Account Number
Address
Telephone Number
Name
Account Number
Address
Telephone Number
Real Estate Mortgages
Lean Holder's Name 1
Address 1
Lean Secured by 1
Lean Holder's Name 2
Address 2
Lean Secured by 2
Other Liabilities (Describe)
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