To serve you better, you may complete the form and submit it electronically. However, you may also print the form and fax it to 972-780-7114. Thank you.

Business Name:
Billing Address:
City, State, Zip
Phone:
Fax:
Email Address:
Corporation?
Owner's Name:
Owner's Phone:
Years in Business:
Number of Vehicles:
Estimated Monthly Purchases:
Purchase Orders?

Trade References:

Name:	Address	Phone
I/We hereby authorize your investigation through above references, credit bureau or other investigative agency as to my/our credit and financial responsibility. I/We understand that an account with Texas Oil X Change, Inc. is due and payable by the 10th of the month following the date of purchase and if not paid by the 15th of the month following the purchase the account may be discontinued at Texas Oil X Change's option. It is understood that if the account is not paid by the 15th of the month, it becomes past due, and interest at the rate of 1-1/2% interest per month, but not more than prohibited by law, will be added to the account each month until paid. In the event it becomes necessary for you to incur any collection costs or if suit is filed to collect under this agreement, the undersigned promises to pay such additional costs of collection and costs of suit, including legal fees. Checks should be made payable to "Texas Oil X Change".
Authorized Person's Name	Title	Date
Personal Guarantee In consideration of Texas Oil X Change extending credit to Applicant: I/We hereby personally guarantee any and all amounts owed by the above to Texas Oil X Change. I/We further agree that upon demand I/We shall personally pay all amounts owing to the amount to Texas Oil X Change, without any need for Texas Oil X Change to exhaust its legal remedies against Applicant. In the event it becomes necessary for you to incur any collection costs or if suit is filed to collect under this agreement, the undersigned promises to pay such costs of collection and costs of suit, including legal fees.
Name	Signature (if faxing)	Date