Credit — Maine Standard Biofuels

Credit Application
By filling out this form and pressing “submit” you are electronically signing this agreement.

My signature below certifies that the information on this application is true.
- I authorize Maine Bio-Fuels, Inc. to investigate my credit.
- I agree to pay a late fee of 1.5% per month finance charge if my bill is 30 days past due.
- I agree to pay a $25 fee for all returned checks.
- I am responsible for all collection costs, which may include attorney fees, filing and court costs, and all other charges incurred, including finance charges and late fees, if I fail to pay my account in a timely manner.
Personal Information
Name *

First Name Last Name
Phone Number *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Email *
example@example.com
Social Security Number *
Date of Birth *

- Month - Day Year
Date

Employer Information
Employer Name *

Employer Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Employer Phone
Length of Employment
Job Title
Annual Household Income *
Do You Have a Co-Applicant? *

Co-Applicant Information
Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
Email *
example@example.com
Date of Birth

- Month - Day Year
Date
Social Security Number *
Employer Name

Employer Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Employer Phone
Length of Employment
Job Title
Annual Household Income *

Application Submit
By filling out this form and pressing “submit” you are electronically signing this agreement.

My signature below certifies that the information on this application is true.
- I authorize Maine Bio-Fuels, Inc. to investigate my credit.
- I agree to pay a late fee of 1.5% per month finance charge if my bill is 30 days past due.
- I agree to pay a $25 fee for all returned checks.
- I am responsible for all collection costs, which may include attorney fees, filing and court costs, and all other charges incurred, including finance charges and late fees, if I fail to pay my account in a timely manner.
I... *

Agree Disagree
Name *

First Name Last Name
Should be Empty: