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

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.