Olson Energy Service


Credit Application

Please complete, print, sign and submit by faxing to: 206.782.1303. Thank you.

Full Name:


Social Security Number:


Spouse (optional):


Social Security Number:


Delivery Address (street, city, state, zip):


Billing Address (street, city, state zip):


Phone:


Fax:


Mobile Phone:


Own: Rent:
Name and Address of Landlord (Renter's Only):


Landlord phone:


Previous Address (street, city, state, zip):


Employer: Work Phone:


Spouse's Employer (optional): Spouse's Work Phone:


Credit Reference:


Phone:


Emergency Contact (Name, Address, Phone):


Account Type: Automatic Misc. Other

Tank Size: Inches: Rate:
Tank Location:


Payment Plan: Credit Card: MasterCard Visa Discover

Card Number:
Expiration Date:

30-Day Account
40% Budget Account
12 Month Budget Account

Remarks:


Annual Service
Tank Agreement

OLSON ENERGY SERVICE IS HEREBY AUTHORIZED TO KEEP MY TANK FILLED AUTOMATICALLY I AGREE TO NOTIFY OLSON ENERGY SERVICE SHOULD I WISH TO TERMINATE SERVICE.

ALL CURRENT QUOTED PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE. THE ABOVE INFORMATION IS WARRANTED TO BE TRUE AND I HEREBY AUTHORIZE OLSON ENERGY SERVICE TO INVESTIGATE IT.

Date: ____________  Signature: ______________________________________________

Sales Representative:




A) 30-DAY ACCOUNT   B) 40% BUDGET   C) 12 MONTH BUDGET

I understand that this Agreement will not become effective until opened by Olson Energy Service and, if opened, I agree that the following terms will govern any charge account established by you for my use.
  1. I will pay Olson Energy Service for all goods and services charged to my Account which are made by or authorized by me, plus FINANCE CHARGES, if any. Payment is effective on the date received by Olson Energy Service.

  2. A) If I have a 30-DAY ACCOUNT, I will pay the new balance shown on my monthly billing statement in full by the 10th of the month.
    B) If I have a 40% BUDGET ACCOUNT, I will pay by the 10th of the month:
    1. The new balance shown on my monthly statement in full or 40% of the total outstanding balance.
    C) If I have a 12 MONTH BUDGET ACCOUNT, I will pay by the 10th of the month:
    1. The new balance shown on my statement in full, or
    2. The minimum monthly payment shown on my monthly statement, which will be determined by Olson Energy Service, or
    3. It is understood that the monthly budget payment is based on my annual oil usage. Any charges other than service or tank contracts added to my account will be paid in addition to my last budget payment.

  3. REGARDLESS OF THE OPTION ABOVE WHICH I CHOOSE, I UNDERSTAND AND AGREE THAT MY ACCOUNT WILL BE PAID IN FULL BEFORE THE NEXT HEATING SEASON WHICH BEGINS SEPTEMBER 1ST OF EACH YEAR, UNLESS SPECIAL ARRANGEMENTS ARE AGREED TO BY OLSON ENERGY SERVICE.

  4. If I fail to pay according to the terms above, I agree to pay the required monthly payment and FINANCE CHARGE at a Monthly Periodic Rate of 1-1/2% (an ANNUAL PERCENTAGE RATE of 18%) assessed upon the "Adjusted Balance" of my account. The "Adjusted Balance" is the balance I owed at the end of the previous billing cycle, less any payments or credits received during the current billing cycle.

  5. IF I DEFAULT IN THE PERFORMANCE OF ANY OBLIGATIONS TO YOU UNDER THIS AGREEMENT, OR IF I TERMINATE SERVICE, MY ENTIRE BALANCE MAY, AT OLSON ENERGY SERVICE’S OPTION, BECOME DUE AND PAYABLE IN FULL. Your waiver of any default shall not operate as a waiver of any default. In the event my account is referred for a collection to any attorney or collection agency who is not your salaried employee, I will pay, to the extent permitted by law, reasonable attorney’s fees and costs.

  6. This agreement may be terminated at any time either by Olson Energy Service or me upon notice to the other. Such termination shall not effect my then existing obligations.

  7. This agreement may be amended from time to time by Olson Energy Service giving me written notice. Unless I terminate this agreement prior to the effective date of the amendment, I will be deemed to have agreed to such amendment. Any purchases made after the effective date of any amendment shall be construed as acceptance of the terms of the amendment.
NOTICE TO BUYER
  1. Do not sign this retail charge agreement before you read it or if any spaces intended for the agreed terms are left blank.

  2. You are entitled to a copy of this charge agreement at the time you sign it.

  3. You may at any time pay off the full unpaid balance under this charge agreement.

  4. You may cancel any purchases made under this charge agreement if the seller or his/her representative solicited in person such purchase, and you sign an agreement for such purchase, at a place other than the seller’s business ad dress shown on the charge agreement, by sending notice of such cancellation by certified mail return receipt requested to the seller at his address shown on the charge agreement, which notice shall be posted not later than midnight of the third day) excluding Sundays and holidays) following the signing of the purchase agreement. If you choose to cancel this purchase, you must return or make available to seller at the place of delivery any merchandise, in its original condition, received by you under this purchase agreement.

  5. I understand that by signing the reverse side of this agreement, I am legally bound to the terms stated above.



Please complete, print, sign and submit by faxing to: 206.782.1303. Thank you.

Olson Energy Service
4415 Leary Way NW
Seattle, WA 98107
phone: 206.782.5522
fax: 206.782.1303


please contact us with any questions at 206.782.5522
or email us at team@olsonenergy.com

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