Business Credit Application

In consideration of credit being extended by SchagrinGAS Company to the named applicant for merchandise to be purchased whether applicant be an individual or individuals, a proprietorship, a partnership, corporation, or any other entity, the undersigned guarantor or guarantors each herby contract and guarantee to SchagrinGAS Compnay the faithful payment, when due, of all accounts of said applicant for purchases. The undersigned guarantor of guarantors each hereby expressly waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment, and demand for payment on applicant, protest and notice to undersigned guarantor or guarantors of dishonor or default by applicant or with respect of partial payment or partial compromise, all other notices to which the undersigned guarantor or guarantors might otherwise be entitled and demand payment under this guarantee. Any revocation of this guarantee shall be in writing and delivered to SchagrinGAS Comapny, ATTN: Credit Manager, P.O. Box 427, Middletown, DE 19709-0427.

Business Information

Business Name (required)

Telephone (required)

Fax (required)

Billing Address (required)

City (required)

State (required)

Zip (required)

Years/Months At billing address (required)

Delivery Address (required)

Previous Address(if less than 2 years) (required)

Type of business (required)

Date Established (required)

How long in business? (required)

Do you require a purchase order or job number?

Do you require a written purchase order?

Does state, county or city require a licence?

License #

Joint Applicant Information

Business Type



Email Address

Street Address




Work Phone

Trade References (Name suppliers of major products and services)

Trade Reference 1

Name (required)

Address (required)

Phone (required)

Trade Reference 2

Name (required)

Address (required)

Phone (required)

Trade Reference 3

Name (required)

Address (required)

Phone (required)

Bank References

Bank Reference 1

Name (required)

Address (required)

Phone (required)

Contact (required)

Bank Reference 2

Name (required)

Address (required)

Phone (required)

Contact (required)

Number of Employees (required)

Estimated Annual Sales (required)

Sales Area (required)

Has the firm or any of its Principals ever been bankrupt?

Applicant agrees to pay any collecion costs incurred to collect the unpaid balance, including interest on the unpaid balance as allowed by state law and any reasonable attorney's fees incurred, and further agrees to pay SchagrinGAS Company regardless if personal or corporate bankruptcy is filed. The undersigned as an inducement to grant credit warrants that the information submitted is true and correct. You are authorized to investigate the credit references listed above.