Maritime Energy’s Secure & Convenient Online Commercial Credit Request Application

Please fill out the form below. If you have any questions, please contact us at Chris Seavey, chriss@maritimeenergy.com or by calling 207-596-0986 ext. 128

APPLICANT INFORMATION

Applicant Name(Required)

First Middle Last Suffix

Applicant Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone

BUSINESS INFORMATION

Business Name(Required)

Business Open Date(Required)

Business Contact Email(Required)

Business Phone(Required)

Website

Business Type(Required)

Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Tax ID # (TIN)(Required)

Tax Exempt?(Required)

If yes, you will be prompted to attach documentation proving that you are Tax Exempt. Without proper documentation taxes will be applied.

Tax Exempt Documents

Drop files here or

Max. file size: 50 MB, Max. files: 10.

Business Owner's Name(Required)

Full Legal Name

Business Owner's SSN(Required)

This field is secured with encryption and can only be viewed by our Credit Department.

Business Owner's Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Is there a secondary business owner or partner to include?(Required)

Secondary Business Owner's Name(Required)

Full Legal Name

Secondary Business Owner's SSN(Required)

This field is secured with encryption and can only be viewed by our Credit Department.

Secondary Business Owner's Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Accounts Payable Contact(Required)

Full Name

Email(Required)

Phone(Required)

CREDIT REQUESTED

Payment Personally Guaranteed By:

Full Legal Name

Guarantor's SSN

This field is secured with encryption and can only be viewed by our Credit Department.

Guarantor's Address

Street Address Address Line 2 City State ZIP Code

Signature(Required)

BUSINESS HISTORY

Date Opened at Current Address(Required)

Was the Current Business Operated Under a Previous Business Name?(Required)

Previous Business Name (If Applicable)

Start Date for Previous Business Name

End Date for Previous Business Name

Was the Current Business Operated at a Previous Location than Current?

Previous Business Location

Street Address Address Line 2 City State ZIP Code

Start Date for Previous Location

End Date for Previous Location

Demand The balance due under this agreement shall be payable on demand. If the applicant files or has filed against it a petition in bankruptcy or makes an assignment of the agreement for the benefit of creditors, the balance of principal and interest under this agreement shall immediately be due and payable without further demand or notice.

Finance Charge Interest will be charged beginning on the first day of the second full month following any statement date and the rate of 18% per year on any unpaid balance still due at the time for all or any portion of the amount shown on the said statement calculated a 1 and ½ per month.

The undersigned applicant seeks to purchase products of Maritime Energy on credit and applies for such credit from Maritime Energy on the terms and conditions stated herein. All statements made by the applicant on this form are true and accurate to the best of the applicant’s knowledge and belief. The applicant authorizes Maritime Energy to make any and all inquiries necessary for action on this credit application and promises to indemnify and hold harmless Maritime Energy and its agents from any liability resulting from their credit inquiry.

Credit Requested Confirmation Terms The undersigned applicant seeks to purchase products of Maritime Energy on credit, and applies for such credit from Maritime Energy on the terms and conditions stated herein. All statements made by the applicant on this form are true and accurate to the best of the applicant’s knowledge and belief. The applicant authorizes Maritime Energy to make any and all inquiries necessary for action on this credit application, and promises to indemnify and hold harmless Maritime Energy and its agents from any liability resulting from their credit inquiry.

Agreement Terms This agreement shall remain in effect until terminated in writing by Maritime Energy of Rockland, Maine. Termination will be effective thirty (30) days after notice is mailed to the applicant at its above address

Authorized Signature Printed Name(Required)

Full Legal Name

Title(Required)

Position Held Within the Company

Date(Required)

Signature(Required)

CREDIT REFERENCES

Do you have an existing Credit Reference Form?

If Yes, please upload, if No, please fill out the form

Upload Existing Credit References

Drop files here or

Max. file size: 50 MB, Max. files: 5.

Please upload a copy of your credit references. If preferred, you may skip this and provide us a copy via e-mail, fax, mail, or drop off at one of our fuel office locations.

CREDIT REFERENCE FORM

Company Name

Account No.

Date of Last Business with Company

Address

Street Address Address Line 2 City State ZIP Code

Company Name

Account No.

Date of Last Business with Company

Address

Street Address Address Line 2 City State ZIP Code

Company Name

Account No.

Date of Last Business with Company

Address

Street Address Address Line 2 City State ZIP Code

BANKING INFORMATION

Type of Account of Loan:

Date Opened

Account No.

Name of Financial Institution

Full Business Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Commercial Credit Application

Maritime Energy’s Secure & Convenient Online Commercial Credit Request Application

APPLICANT INFORMATION

BUSINESS INFORMATION

CREDIT REQUESTED

BUSINESS HISTORY

CREDIT REFERENCES

CREDIT REFERENCE FORM

BANKING INFORMATION

Accounts

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