General Credit Application

682.385.5834
PTL.Credit@pilotthomas.com

Please contact us if you need assistance throughout the application process.

Company Information

Business Information

Please provide us with copies of all tax exemption certificates.

Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.

Bank Information

NOTE: Failure to include bank information and trade references via upload or by entering into the fields below could result in a processing delay for your credit application.

Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.

Trade References

Please Read Carefully Before Signing

I/We certify that the foregoing information has been supplied truthfully, accurately and voluntarily, and therefore authorize named creditor to investigate my/our creditworthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means, including direct contact with past and present creditors. I/We also authorize banks and other financial institutions to give information to Pilot Thomas Logistics in connection with this transaction about my/our savings, checking accounts, and loans. If credit is extended as a result of the application, I/We agree to make payment promptly in accordance with the creditor’s terms.

Financial statements should be included with this application to process your request.

Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.

Terms and Conditions of Receiving Credit

Please click here to download the terms and conditions, which must be included in order to complete your credit application. Any modifications to the terms and conditions must first be approved by our Credit Department before being finalized in the Master Service Agreement.

Please attach your signed terms and conditions form below.

Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.

Tax Information

You are required to sign and attach the W-9 form, which can be downloaded by clicking here. If you require forms for exemptions, please contact your sales representative directly, this application package will not apply. Your account will not be exempted from taxes.

Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.

***Please ensure that your W-9 has been signed and dated within the last year.***

Customer Contact Information

This information must be provided to ensure your account is set up with the proper contact information.

Delivery / Invoice Requirements

Payment terms will come from seller's credit department upon approval.

All customer invoicing is sent electronically. If the proper email address for receiving invoices is not the Accounts Payable listed above, please provide the correct email address below:

Product(s) to be purchased:

**Upload certificate for Dyed Diesel below.**

Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.

Electronic Funds Transfer (EFT) Authorization

If you would like Pilot Thomas to debit your account when payment is due please check the box below, complete the Electronic Funds Transfer Agreement and include a copy of a voided check.

does hereby authorize Pilot Thomas Logistics (PTL) to initiate debit and/or credit entries to Customer’s account at Customer’s financial institution, as indicated below, relative to payment by Customer for products purchased from PTL.

This agreement will be effective as to PTL’s invoices stated after PTL’s acceptance of this agreement and will remain in effect until terminated by either party by giving fifteen (15) days prior written notice to the other party at Customer’s address above or to Pilot Thomas Logistics, 201 N. Rupert Street, Fort Worth TX, 76107. Notice of termination of this agreement will in no way affect any debit or credit transaction initiated prior to the expiration of this agreement, nor release Customer from its payment obligations to PTL for products purchased from PTL for which payment is outstanding at the time of termination of this agreement.

Customer further authorizes the named financial institution to debit and/or credit Customer’s account as set forth in this agreement. Entries, debits and credits to Customer’s account will be made only as authorized by the terms of this agreement. PTL agrees that no single entry initiated under this agreement will be in excess of the amount due unless specifically authorized by the Customer. Customer agrees to reimburse PTL for any administrative, legal and/or banking costs and expenses incurred or charged to PTL as a result of returned items.

I understand and acknowledge that this credit application, the authorization, and all terms and conditions apply to any transactions conducted with all subsidiaries such as Thomas Petroleum, LLC, Pilot Thomas Logistics, LLC, General Petroleum Corporation, Rainier Petroleum Corporation, Simons Petroleum, LLC, Maxum Petroleum, Inc. and Petroleum Products, LLC. 

Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.

Continuing Guaranty

Click here to download the Continuing Guaranty in order to complete your Credit Application. Any modifications or disputes must first be approved by our Credit Department before being finalized in the Master Service Agreement.

Please attach your completed guaranty form below.

Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.