PERSONAL CREDIT APPLICATION

Do you have a Co-applicant?

Co-Applicant Information

Commodity to be Purchased

Select commodities below. More than one may be selected. Once selected, the form will appear.

Propane Tank Icon Please fill out the propane information below
Will deliver propane on route basis. Must have credit approved and remain current.
Leak check could be done on new customer’s system at no charge.
Propane Tank Icon Please fill out the propane information below
Will deliver propane on route basis. Must have credit approved and remain current.
Leak check could be done on new customer’s system at no charge.
Propane Tank Icon Please fill out the propane information below
Will deliver propane on route basis. Must have credit approved and remain current.
Leak check could be done on new customer’s system at no charge.
Propane Tank Icon Please fill out the propane information below
Will deliver propane on route basis. Must have credit approved and remain current.
Leak check could be done on new customer’s system at no charge.
Propane Tank Icon Please fill out the Cardtrol Card application information below
This agreement, made and entered by and between . Hereinafter referred to as “Customer” and W & H Cooperative Oil Company, hereinafter referred to as W & H.

Cardtrol Card(s) may be used to operate the fuel pumps at W & H locations in Humboldt, Fort Dodge, Eagle Grove, Renwick, Livermore, Badger, Clare, Vincent, and Goldfield.

1. Customer agrees to comply with the credit policy of W & H, which states that credit purchases are subject to a finance charge of 1.5% per month with a minimum charge of $.50 for any month in which a finance charge is imposed. No finance charge is imposed if the balance at the end of the month is paid by the 15th day of the following month and I hereby agree to pay any such charges assessed. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department.

2. In the event of a lost or stolen card, Customer agrees to immediately notify W & H Office, which will then promptly render that card invalid. Until such date and hour as Customer has so notified W & H of a lost, stolen or misplaced card, Customer shall remain liable for all purchases recorded on the Customer’s statement. Upon notification of the loss or disappearance of any card, W & H agrees to issue the customer a new card with a new pin.

3. Customer agrees to not leave the dispensing equipment unattended at any time while it’s being operated and to accept the responsibility of controlling sources of ignition. The customer agrees to abide by all state fire regulations and also Environmental Protection Agency rulings while utilizing the Cardtrol System.

4. Customer may terminate this agreement at any time by returning all the cards to W & H with payment in full for their charge account.

5. Customer understands that the Pin number is a special 4-digit number which must be manually entered every time the customer purchases fuel. A pin is used for security. Please store your pin separately from your cardtrol card.

The undersigned hereby unconditionally guarantee(s) payment when due, and agrees to pay all expenses (including attorney’s fees and legal expenses incurred by W & H to collect the debt and enforcing this guarantee).

Fill Tank Icon Please fill out the tank wagon gas and diesel information below
Tank Wagon Delivery Information
Fill Tank Icon Please fill out the tank wagon gas and diesel information below
Tank Wagon Delivery Information
Fill Tank Icon Please fill out the tank wagon gas and diesel information below
Tank Wagon Delivery Information
Fill Tank Icon Please fill out the tank wagon gas and diesel information below
Tank Wagon Delivery Information
Fill Tank Icon Please tell us what other commodity you are interested in purchasing

Acknowledgements and Agreements

I represent that the above information is true and is given to induce W & H Cooperative Oil Company to extend credit to the applicant. My company and I hereby authorize W & H Cooperative Oil Company or any credit bureau or other investigative agency employed by W & H Cooperative Oil Company to investigate any reference herein listed or statements or other data obtained from me or from any person pertaining to the company’s credit and financial responsibility. I UNDERSTAND AND AGREE THAT CREDIT PURCHASES ARE SUBJECT TO A FINANCE CHARGE OF 1.5% PER MONTH, WITH A MINIMUM MONTHLY CHARGE OF $.50 FOR ANY MONTH IN WHICH A FINANCE CHARGE IS IMPOSED. NO FINANCE CHARGE IS IMPOSED IF THE BALANCE AT THE END OF THE MONTH IS PAID BY THE 15TH DAY OF THE FOLLOWING MONTH, AND I HEREBY AGREE TO PAY ANY SUCH CHARGES ASSESSED. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department. The undersigned agrees to pay for all costs, attorney fees, and other expenses that W & H Cooperative expends or incurs in the collection of any indebtedness for credit extended under this credit application.

Annual percentage rate for purchases that finance charge is imposed
18%
Grace period for repayment of balances for purchases
If you pay your account balance as of the end of the month on or before the 15th day of the following month, then no finance charge will be imposed.
Method of computing the balance for purchases
We figure the finance charge on your account by applying the periodic rate to the “adjusted balance” of your account. We get the “adjusted balance” by taking the balance at the beginning of the month and subtracting unpaid finance charges and payments and credits received during the month.
Minimum finance charge
There is a minimum finance charge of $.50 for any month in which a finance charge is imposed.

I/We the undersigned, being eligible for membership in the W & H Cooperative Oil Company of Humboldt, Iowa, hereby apply for membership which, upon acceptance, will be acknowledged and duly recorded by the issuance of a certificate for one share of common stock at a total purchase price of $10.00.

I/We the undersigned agree to the following:

  1. The undersigned has received a copy of the articles of the association.

  2. The undersigned may review the most recent annual report of the association at the corporate office in Humboldt.

  3. The undersigned agrees to take any applicable patronage refunds into taxable income in the taxable year in which such written notices of allocation are received, in accordance with the by-laws of the association.

  4. The undersigned is a person who customarily uses the supplies, commodities, or services of the association.

Checks for the $10.00 membership fee can be made out to W & H Cooperative and mailed to PO Box 528 Humboldt IA 50548 OR can be paid over the phone with a card at 515-332-2782

The membership of the association is not transferable, except for repurchase by the association.

This application is subject to acceptance by the association and shall be fully effective and irrevocable upon acceptance by the board of directors or the association without written notice by the secretary to the undersigned.

Please issue membership as follows

W-9 Information

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