Sign Up for Service | Cole Oil & Propane

CUSTOMER TYPE*

Residential
Business

Residential Customer Information

First Name*

Last Name*

Date of Birth*

Additional Name(s) on Account (If Applicable)

Primary Phone*

Primary Phone Description [e.g. Home, John Cell]

Secondary Phone

Secondary Phone Description [e.g. Home, John Cell]

Email

Email Invoices & Statements?*

Yes
No

MAILING ADDRESS*

Address City State Zipcode

DELIVERY ADDRESS*

Same as Mailing Address

Address City State Zipcode

Rent or Own?*

I RENT this property
I OWN this property

Landlord Contact Information

*Required for Renters

Landlord's Name*

Landlord's Phone*

Landlord's Address

Address City State ZIP Code

Business Information

Business Name*

Corporation
LLC
Partnership
Sole Proprietor

In Business Since

Federal Tax ID/FEIN

Are you WI Sales Tax Exempt?*

Yes
No

Cole Oil & Propane is required by law to charge sales tax on all purchases unless customer has provided a completed, signed copy of WI Sales Tax Exempt Form S-211.

Attach Document(s)

Max. file size: 128 MB.

MAILING ADDRESS*

Address City State ZIP / Postal Code

Contacts

BILLING:*

Name	Phone	Email

Email Invoices & Statements?*

Yes
No

OTHER:

Name/Title	Phone	Email

References

A minimum of two (2) trade references and one (1) bank reference is required.

Trade Reference 1	Address/Location	Contact Number	Account Number

Trade Reference 2	Address/Location	Contact Number	Account Number

Trade Reference 3	Address/Location	Contact Number	Account Number

Bank Reference	Address/Location	Contact Number	Account Number

Service & Tank Information

DELIVERY ADDRESS*

Same as Mailing Address

Delivery Address City State ZIP / Postal Code

Type of Service (Check All That Apply):

Propane
Fuel Oil
Diesel/Gasoline
Lubricants
Cylinder Exchange

Propane Application/Use*

*Select all that apply*

Heat
Hot Water
Fireplace
Stove
Clothes Dryer
Garage/Shed
Pool
Other

Fuel Delivery Customers:

I don't have a tank
I own my tank(s)
I lease my tank(s) from another supplier

Tank Size	Current Tank Level	Will Call or Auto Fill?

Tell us what we can do for you!

Referral Information

How did you hear about us?*

If one of our employees or current customers sent you, please fill in their information below. We’d love to thank them!

Customer Referral Program Details

Customer or Employee Name*

Customer Account Number

Customer Address

Payment Terms

I have read and agree to the following terms: *Terms are Net 30 Days. A finance charge of 1.5% per month (18% annual) will be charged on all past due amounts* Open payment terms are subject to the Cole Oil’s credit department approval. Renter Terms are COD (payment required up front). Customers not leasing equipment from Cole are COD for the first year of service, or until credit is established/approved.

I have read and agree to the following terms: *Terms are Net 30 Days. A finance charge of 1.5% per month (18% annual) will be charged on all past due amounts* Open payment terms are subject to the Cole Oil’s credit department approval. Renter Terms are COD (payment required up front).

THE INFORMATION PROVIDED ON THIS APPLICATION IS PROVIDED FOR THE PURPOSE OF OBTAINING BUSINESS CREDIT FOR THE ABOVE-NAMED APPLICANT AND IS WARRANTED TO BE TRUE. OPEN PAYMENT TERMS ARE SUBJECT TO THE SELLER’S CREDIT DEPARTMENT APPROVAL. CREDIT AVAILABILITY FOR NEW AND EXISTING CUSTOMERS IS PERIODICALLY REVIEWED. I AGREE THAT ALL ACCOUNT BALANCES ARE DUE AND PAYABLE NET 30 DAYS FROM INVOICE DATE. I UNDERSTAND THAT FAILURE TO PAY TO TERMS MAY RESULT IN SHIPMENT(S) BEING HELD UNTIL ALL BALANCES ARE PAID IN FULL. APPLICANT EXPRESSLY AGREES THAT IT SHALL BE LIABLE AND PAY ALL ATTORNEYS’ FEES, COLLECTION COSTS AND COURT FEES, AND ANY OTHER EXPENSES, WHETHER OR NOT INCURRED IN CONNECTION WITH LITIGATION, INCLUDING BUT NOT LIMITED TO ATTORNEYS’ FEES AND COSTS ASSOCIATED WITH THE ENFORCEMENT OF ANY OF THE TERMS OF THIS APPLICATION AND ATTORNEY’S FEES AND COSTS RESULTING FROM A DEFAULT UNDER THIS APPLICATION. I HEREBY CERTIFY THAT I AM AUTHORIZED TO ACT FOR AND TO BIND THE APPLICANT LISTED ABOVE TO THESE TERMS AND CONDITIONS *ILLEGIBLE, INCOMPLETE OR UNSIGNED APPLICATIONS WILL BE RETURNED FOR CORRECTION.

Cole Oil & Propane requests all businesses to sign a Personal Guaranty.

Upload *signed* Personal Guaranty here: