(908) 995-4825  
760 Frenchtown Road, PO Box 619, Milford, NJ 08848-0619
JD Stem, Master HVACR Contractor Lic. #4246 • PA HIC #PA032216

  Credit Application



1st Name
Social Security Number
The last four digits of your SS# is acceptable
Use spaces or 'X' to skip values
Date of Birth
2nd Name or T/A
Social Security Number
The last four digits of your SS# is acceptable
Use spaces or 'X' to skip values
Date of Birth

Billing Address
City
State
Zip
Delivery Address
City
State
Zip
Owner 
Renter 
Landlord

How many years at this location?
Previous Dealer
Telephone #
E-mail Address
Work #
Cell #
Employer
Primary Bank
How did you hear about us?
Other

In order to continue the delivery of energy products or services, please complete and return this application immediately. We cannot make any future deliveries without this form being returned!

Company is responsible for the delivery of Bioheating Oil, Kerosene, Biodiesel Fuel, Propane and Gasoline to the receiving pipe or outlet designated by the customer. Customer acknowledges and agrees that neither the company, nor its employees or agents, are or shall be liable under any circumstances for any damages resulting from leaks or for the failure of the receiving tank or associated piping, or any other matter.

In addition, for products and services rendered, payment in full is due 15 days from time of delivery or service. Accounts that are overdue will be subject to a 1.5% finance charge (18% annually) if payment is not received in this office prior to 30 days. Also, no further deliveries can be made until paid in full. There is a $25.00 charge for each returned check. In the event that a collection agency or attorney is utilized to enforce or collect payment of debt, you agree to reimburse Stem Brothers, Inc. the cost of any collection agency fees, which may be charged up to a maximum of 50% of the debt, and all costs and expenses including reasonable attorney’s fees we incur in such collection efforts.

I certify that all the information on the credit application is true and complete and I agree that inquiries can be made to procure my credit report. If this is a joint application, the undersigned shall be jointly and severally liable for any unpaid balances for products delivered, parts and/or services rendered.

In addition, initially, I request that deliveries be made to me in the following manner.

I agree that I do not have to be present when deliveries are made by Stem Brothers, Inc. and will be responsible for the payments. Also, if I am an automatic delivery customer, I authorize future deliveries and guarantee payment of them. These terms apply to all of my accounts for products delivered, parts sold and all services rendered.


Please note: On joint accounts, both parties must sign the application.
Signature

Date
Signature

Date