Business Application – Sequoia Gas

Contact Name*

First Last Title

Company Name*

Contact Phone*

Contact Fax

Contact Email*

Business and Credit Information

Billing Address*

Street Address Address Line 2 City State ZIP Code

Accounts Payable contact person

Accounts Payable Phone number

Accounts Payable Email Address

Date Business Commenced

Type of Business

Sole Proprietorship
Partnership
Corporation
Other

Federal Tax ID Number

Resale Number (If Applicable)

Property Address*

Street Address Address Line 2 City State ZIP Code

How Long At The Current Address

Property Phone

Property Fax

Property Email

Are You Interested In Receiving E-Statements?

Yes
No

Bank Name

Bank Primary Business Address

Street Address Address Line 2 City State ZIP Code

Bank Phone

Account Number

Type of Account

Savings
Checking
Other

Business and Trade References

Company 1 Name

Company 1 Address

Street Address Address Line 2 City State ZIP Code

Type of Account

Company 1 Phone

Company 1 Fax

Company 1 Email

Company 2 Name

Company 2 Address

Street Address Address Line 2 City State ZIP Code

Type of Account

Company 2 Phone

Company 2 Fax

Company 2 Email

Authorization*

I agree to the authorization terms

By submitting this form, I authorize the above references and credit bureaus to release our financial information to Sequoia Gas Co.

The above information is given for the purpose of establishing an account and is a true statement. In consideration for the extension of credit, purchaser agrees to the terms of sale set forth on each invoice and/or contract. Purchaser agrees to pay a service charge on all outstanding balances at the monthly rate of 2% per our terms. In the event collection is needed, purchaser agrees to pay all costs.