APPLICATION FOR CREDIT

Full Name______________________Social Security No.__________________________

Home Address___________________City_______________State_____Zip Code_________

How Long____________Own/Rent_________Telephone No_________________________________

 

Employer_____________________________Address________________________________________

Position _______________________ How Long_________Monthly (net) Income $_______________

 

Co-Applicant’s Name_________________________Social Security No__________________________

Co-Applicant’s Employer__________________________Address______________________________

Position______________________How Long_________Monthly (net) Income $__________________

 

If Renting, Name of Landlord____________________Address_________________________________

Monthly Rental Payment $_______________

 

Name of Nearest Relative Other than Husband or Wife________________________Address______________________________

Relationship_______________________Telephone No________________________________________

The above information is for the purpose of obtaining credit and is warranted to be true. I agree to pay all

bills upon receipt of statement or otherwise expressly agreed.

MANDATORY NOTICE PROVISION IN WRITTEN CREDIT APPLICATION

You are applying for credit, which may be governed by the Wisconsin Consumer Act. As required by Marital Property Reform Act, you are hereby notified that neither a marital property agreement, a unilateral statement under sec. 766.59, Wisconsin Statutes, will adversely effect the interest of any creditor or you unless, before the credit is granted, that creditor is furnished a copy of such agreement, statement or decree or had actual knowledge of the adverse provision when the obligation of the creditor was incurred.

                   Date:                   Applicant's Signature                                                                 
Co-Applicant's Signature                                                                           
                                                                               
    Date Approved:                                     Kristen Ganser, Credit Manager
          Credit Limit:                  

 

INDIVIDUAL CONSENT AND CERTIFICATON OF TAXPAYER I.D. NUMBER

 

 
                                                                                                                                 
Name Taxpayer ID #, SSN, or EIN
                                                                                                                      
Address Phone
                                                                                  /        /           
City        State Zip Code       Birth Date

I hereby consent to include in my gross income, as now or hereafter provided in the federal income tax laws, the stated dollar amount of each written notice of allocation which I receive from Consumers Coop Oil Company with respect to my patronage occurring during the current and all subsequent taxable years of this cooperative. This consent shall be revocable by me at any time if in writing.

 

 

Certification – Under penalties of perjury, I certify that (1) the number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and (2) I am not subject to backup withholding because: (a) I am exempt form backup withholding, or (b) I have not been notified by the internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.

 

Certification Instructions – You must cross out items (2) above if you have been notified by the IRS that you are currently subject to backup withholding because of underreporting interest or dividends on your tax return. However, if after being notified by the IRS that you are no longer subject to backup withholding, do not cross out item (2).

 

The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid back withholding.
                                                                                                                              
Signature Date

 

 

 

 

 

SUBJECT: CREDIT POLICY & ACCOUNT PROCEDURE

As a result of the present Consumer Act, we must have your signature on our Credit Plan or credit cannot be extended. Please read the credit plan, sign it, and return as soon as possible.

The Board of Directors unanimously adopted this plan and your General Manager and Credit Manager have been instructed to enforce it. Failure to sign and return the Credit Plan will automatically classify your account C.O.D.

 

A NEW CASH ONLY ACCOUNT - can be established by the completion of a CONSENT CARD whereby PAYMENT must be made at the TIME OF PURCHASE.

A NEW CHARGE ACCOUNT - can be established by the completion of a CONSENT CARD and CREDIT APPLICATION. The Company will check credit application reference information as promptly as possible. Applicants will be notified of the results of their application as soon as credit determination is made. During this period between application and notification, all purchases must be on a CASH BASIS. When credit is approved, any credit limitations will be a part of the notification. All new accounts may or may not have full open account privileges.

CREDIT POLICY - open account charges made in any one month are DUE AND PAYABLE IN FULL upon receipt of your statement received in the following month. If still not paid on or before the last day of the month, your account will be considered delinquent and will be assessed a 1˝% per month delinquency charge (equivalent to 18% per year) on the unpaid portion. Once an account becomes delinquent 60 days, all sales will be made on a CASH ONLY BASIS. This limitation will continue until the account is paid in full. Accounts that have been frequently delinquent and CASH ONLY must request their open account privileges be reinstated. These are not revolving credit transactions but merely convenience credit transactions and therefore payment of a delinquency charge is not an alternative to payment in full.

The Company may make discontinuance of credit at any time your account becomes delinquent. When credit is discontinued, all future purchases must be on a CASH ONLY BASIS, and satisfactory arrangements for payment of the account balance must be made with the CREDIT MANAGER before further credit may be extended. Upon failure to make satisfactory payments as agreed, the Company may take any and all action it considers necessary to collect the unpaid balance of your account, plus service charges accumulated, collection costs (minimum $25.00 fee) and any other costs to the Company as a result of its actions to collect said account. Consumers Co-op Oil Company reserves the rights to further restrict or limit credit privileges when it deems necessary.

The Board of Directors:

Jerald Kaufman

Steve Kindschi

(President)

(Secretary)

Dan Baun

Kristen Ganser

(General Manager)

(Credit Manager

                                                      

                                                        

(Applicant's Signature)

(Co-Applicant's Signature

Reviewed & Revised: 01/12/2007

 

 

 

 

 

PRODUCTS AND SERVICES AVAILABLE AT CONSUMERS CO-OP:

Please P (check) products/services you are interested in and return to us.

Pump 24 credit cards allow 24/7 fueling at our Sauk City, Prairie du Sac and Plain Cenex stations. Please indicate how many cards you would like to receive: (#).

L.P. Gas Services. Would you like to be on a scheduled delivery route? Yes/ No

Diesel Fuel Delivery. Would you like to be on a scheduled delivery route? Yes/ No

Fuel Oil Delivery. Would you like to be on a scheduled delivery route? Yes/ No

Gasoline Delivery. Would you like to be on a scheduled delivery route? Yes/ No

Heating & Cooling, water heaters, water softeners, sales and service.

Would you like more information or have someone contact you? Yes/ No/ At a later date

WE ALSO HAVE OTHER BUSINESSES IN THE SAUK PRAIRIE AREA THAT I WOULD ENCOURAGE YOU TO PATRONIZE. THEY ARE:

Consumers Quick Lube & Good Year Automotive Center; 15 minute Quick Lube and complete automotive services - 751 Phillips Blvd. (Hwy 12), Sauk City - 643-3476.

Sauk Cenex Convenience Store – 740 Phillips Blvd. (Hwy 12), Sauk City – 643-8033

Sauk Mobil Convenience Mart - 761 Phillips Blvd. (Hwy 12), Sauk City - 643-4773.

Plain Cenex Convenience Store - Hwy 23, Plain - 546-4701.

Prairie Cenex Convenience Store – 1300 Prairie St., Prairie du Sac – 644-0919.

Prairie Mobil Convenience Mart - 493 Water St., Prairie du Sac - 643-2160.

L.P. Cylinder filling for grills, campers, and RVs is available at the Sauk Cenex Convenience Store.

Call 643-8033 for hours.

Car Wash Center; three automatic/touch-less car washes and two self-service bays, located behind the Sauk Cenex Convenience Store or try the new automatic/touch-less carwash (1 bay) at Prairie Cenex, Hwy PF, Prairie du Sac.

Thank you for joining our cooperative. We are looking forward to serving you and supplying your needs. Remember, the more you use, the more you save. If you have any questions, concerns, or comments, please call us at 643-3301 or 1-800-446-3301.

Thank you.

 

Dan Baun

General Manager