Apply Online - Westgate Petroleum

Please fill out our online credit application below. Please call us during regular business hours at
(707) 263-6512 if you have any questions.

If you prefer, you can download a PDF version of this application and fax your completed form to
(707) 263-0225.

Step 1 of 7

Maximum Amount of Credit Requested
i.e. $2,000
Company Name
Company Address
Street Address City California ZIP Code
Phone
Format: (###) ###-####
Fax
Format: (###) ###-####
Email
Enter Email Confirm Email

Bank Reference
Financial Institution Name
Contact Name
Phone
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Account Type
- Checking
- Savings
Account Number

References
Three (3) references are required. One (1) reference should be a current petroleum supplier. References should be with currently OPEN accounts. Credit card references will not be accepted.
Ref. 1 - Name of Company
Contact Name
Account Number
Phone
Fax
Address
Street Address City State / Province / Region ZIP / Postal Code Country

Ref. 2 - Name of Company
Contact Name
Account Number
Phone
Fax
Address
Street Address City State / Province / Region ZIP / Postal Code Country

Ref. 3 - Name of Company
Contact Name
Account Number
Phone
Fax
Address
Street Address City State / Province / Region ZIP / Postal Code Country

Business Information
Type of Business
State
Year
TIN Number
DUNS Number
Principal Business Activity
Date Established
MM slash DD slash YYYY
Building Tenancy Status
- Rent
- Own
- Lease
Rental / Leasing Agency
Agency Phone
Name of Principal
Principal's Phone
Principal's Address
Street Address City State / Province / Region ZIP / Postal Code Country
Have you ever filed bankruptcy?
- Yes
- No
Chapter Type
Bankruptcy Date
MM slash DD slash YYYY

Westgate Petroleum Security Agreement
In consideration of extending credit for the purchase of products, equipment, and/or services for my business or personal use, I agree to the following terms and conditions related to these purchases:
1. Our terms are payment in full within 15 days of delivery.
2. Invoices not paid within assigned terms from date of delivery will be subject to a finance charge of 1.5% per month (annual rate of 18%.) Each returned check will be subject to a $35.00 handling charge. In the event any invoice is not paid when due, the person or company to whom the product, equipment, and or services were furnished agrees to pay all cost of collection including attorney fees. If suit is brought, the customer agrees that the venue will be at the choice of WESTGATE PETROLEUM.
3. It is the responsibility of the customer to provide resale, exemption or other documents, that affect the taxation of purchases. If such are not in the possession of WESTGATE PETROLEUM at the time of sale, the customer is liable for any taxes charged on the sale, regardless of future submission of tax documents.
4. The person or business applying for credit may be required to grant to WESTGATE PETROLEUM security interest in the following collateral (including proceeds thereof) to secure payment of any obligations: all accounts, accounts receivable, and other rights to payment, all equipment, and all inventory, including without limitation all petroleum products, as more specifically stated in the financing statement. The undersigned agree to execute the financing statement and any other documents required for WESTGATE PETROLEUM.
By signing and filling in the information below, you are acknowledging you have read and understand the security agreement terms noted above.
Authorized Signature (Security Agreement)
You may use your mouse (standard devices), stylus or finger (touch screen devices) to sign your name below.
Name
First Last
Job Title
Today's Date
MM slash DD slash YYYY
Personal Guarantee
WE, THE UNDERSIGNED, in consideration of the sales of fuel and related products on open account by WESTGATE PETROLEUM to the company noted in this application in which we are stockholders/owners, hereby guarantee personally and unconditionally the payment when due of any account of said sales and acknowledge that credit would not be available except with this guaranty.
By signing and filling in the information below, you are acknowledging you have read and understand your personal guarantee noted above.
Authorized Signature (Personal Guarantee)
You may use your mouse (standard devices), stylus or finger (touch screen devices) to sign your name below.
Name
First Last
Social Security Number
Today's Date
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Step 1 of 7

Bank Reference

References

Business Information

Westgate Petroleum Security Agreement

Personal Guarantee

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