CA: 800.752.7887    |    AZ: 800.752.7888

SUPREME OIL CREDIT APPLICATION

COMPANY

BUSINESS INFORMATION

Business Type

OWNER, PRINCIPAL AND/OR OFFICER OF THE COMPANY

BANKING REFERENCE

PRESENT FUEL SUPPLIER

TRADE REFERENCES

RESALE CERTIFICATE

I HEREBY CERTIFY: That I hold a valid seller’s permit number
issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling: petroleum products. That the tangible personal property described herein which I shall purchase from Supreme Oil Co. will be resold by me in the form of tangible personal property; provided, however, that in the event any such property is used for any other purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by the Sales and Use Tax Law to report and pay tax, measured by the purchase price of such property or other authorized amount. Description of property to be purchased: petroleum products, including, but not limited to: gasoline, diesel fuel, oil, and lubricants.