SIEGEL ENERGY CORPORATION
CREDIT APPLICATION
303-893-3211 
877-893-3211
FAX 303-595-8741
PLEASE FAX (303-595-8741) OR EMAIL (INVOICES@SIEGELOIL.COM) A COPY OF YOUR TAX ID, TAX EXEMPT CERTIFICATE (IF TAX EXEMPT COMPANY) AND A COPY OF YOUR MOST CURRENT W9.  UPON RECEIPT OF THIS APPLICATION, WE MAY CONTACT YOU FOR MORE INFOMATION AS NEEDED.
SECTION A: COMPANY INFORMATION
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SECTION B:  BANK REFERENCE
SECTION C:  MAJOR TRADE REFERENCE
SECTION D:  SOLE PROPRIETORSHIP OR PARTNERSHIP
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SECTION E:  CORPORATION OR LIMITED LIABILITY COMPANY
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The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the bases of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act.  The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, 1405 Curtis St., Suite 2900 Denver, CO 80202.  The maximum finance charge permitted by the law, presently 1.75% per month (21% annual percentage rate) will be added to unpaid balances of all invoices after 10 days, after deducting current payments.  After default and referral to a collection agent who is not a salaried employee of Siegel Energy Corporation or its assignee, the undersigned shall pay a reasonable collection fee and any judgment in favor of Siegel Energy Corporation or its assignee may include a reasonable collection fee not in excess of 15% of the unpaid debt (unless an additional fee is directed by the court)  The foregoing notwithstanding, the undersign agrees that if Siegel Energy Corporation hires an attorney to collect any unpaid balance owed, the undersign shall pay all reasonable attorney fees and court costs incurred by Siegel Energy Corporation.

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INDIVIDUAL PERSONAL GUARANTEE

For good and valuable consideration, including the extension of credit to the company or companies on this application (“Customer”) from which extension I will benefit, do hereby personally guarantee and promise to pay on demand any obligation of Customer to Siegel Energy Corporation without regard for any claim of setoff, counterclaim or defense. In addition, should there be any invoices not paid according to terms, Customer agrees to pay attorney’s fees and reasonable collection expenses.  I hereby waive notice of sales to Customer, and of the terms thereof, and the non-payment or other default or dispute with Customer. I hereby waive any rights to a jury trial and consent to all renewals and modifications of terms of sale or credit.  This is a continuing and irrevocable guarantee and I hereby subordinate any indebtedness of customer to me that of customer to Siegel Energy Corporation. I hereby certify that all financial information furnished to Siegel Energy Corporation is true and complete and authorize Siegel Energy Corporation to obtain, from time to time, my consumer credit report.

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