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Wednesday, 22 Feb 2012

Commercial Credit Application

All decisions with respect to the extension or continuation of credit shall be at the sole discretion of SIMCOL Group, LLC.

The Commercial Credit Application can be submitted two different ways.  OPTION 1: Submit Credit Application digitally below. OPTION 2: DOWNLOAD Credit Application, then either fax it to 404.921.9602 or email it to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

  1. STEP 1 of 5

  2. GENERAL INFORMATION:

  3. Company Name*
    Please insert Company Name.
  4. (Doing Business As)
    Invalid Input
  5. Business Type*



    Please specify if you have filed for bankruptcy
  6. Contact Name*
    Please insert Contact Name.
  7. E-mail*
    Invalid Email Address.

  9. BUSINESS ADDRESS:

  10. Business Address*
    Please insert Business Address
  11. Business Address 2
    Please insert street address
  12. Business City*
    Please insert Business City
  13. Business State*
    Please select Business State.
  14. Business Zip*
    Please insert Business Zip
  16. Phone No.*
    Please insert Phone Number
  17. Fax No.
    Please insert Fax Number

  19. BILLING ADDRESS:

  20. (If same as Business Address,
    leave blank)
  21. Billing Address
    Please insert street address
  22. Billing Address 2
    Please insert street address
  23. Billing City
    Please insert city
  24. Billing State
    Please tell us how big is your company.
  25. Billing Zip
  27.  
  1. STEP 2 of 5

  2. CREDIT / PURCHASE INFORMATION:

  3. Line of Credit Type*
    Please insert Line of Credit Type
  5. Estimated monthly purchases from
    SIMCOL Group, LLC.
  6. in Gallons*
    Please insert Estimated Gallons
  7. in Gasoline*
    Please insert Gasoline Estimates
  8. in Middle Distillates*
    Please insert Middle Distillate Estimates
  10. Filed for Bankruptcy?*
    Please specify if you have filed for bankruptcy
  11. If Yes, Provide The Following:
  12. Case No.
  13. Date
  14. County
  15. State
    Please tell us how big is your company.

  17. TAX INFORMATION:

  18. Tax Exempt?*
    Please specify if your tax exempt
  19. If Yes, Attach Certificate(s)
    Invalid Input
  21. Date Business began, or if currently
    a Partnership or Corporation, date
    Formed or Incorporated:
  22. Date of Formation*
  23. Doing Business with any SIMCOL Group unit?*
    Please specify if your doing business with SIMCOL Group, LLC
  25. If Yes, Provide:
  26. Name of Unit
  27. Account No.
  29.  
  1. Please skip STEP 3 if you are a Partnership or Proprietorship
  3. STEP 3 of 5

  4. CORPORATION INFORMATION:

  5. Chartered in State of:
    Please select Chartered State.
  7. Name & Title of each Principal
    Invalid Input
  8. Parent Firm(if applicable):
  10.  
  1. Please skip STEP 4 if you are a Corporation or Proprietorship
  3. STEP 4 of 5

  4. PARTNERSHIP INFORMATION:

  5. Legal Name of Partnership
  6. Type of Partnership
    Please specify type of partnership
  8. List Name, Residence and Social
    Security Number of each Partner Below:
  9. Partner(1) Name
    Please insert Partner1 Name.
  10. Partner(1) SS#
    Please insert Partner1 Social Security Number.
  11. Partner(1) Address
    Please insert Partner1 Address.
  12. Partner(1) City
    Please insert Partner1 City.
  13. Partner(1) State
    Please select Partner1 State
  14. Partner(1) Zip
    Please insert Partner1 Zip.
  16. Partner(2) Name
    Please insert Partner2 Name.
  17. Partner(2) SS#
    Please insert Partner2 Social Security Number
  18. Partner(2) Address
    Please insert Partner2 Address.
  19. Partner(2) City
    Please insert Partner2 City.
  20. Partner(2) State
    Please select Partner1 State
  21. Partner(2) Zip
  23.  
  1. STEP 5 of 5

  3. BANK & TRADE REFERENCES:

  4. Please upload all Bank References and Trade References
    [including Petroleum Supplier(s)].
  5. Bank References*
    Please upload all Bank References
    (PDF or .Doc Formats Only)
  6. Trade References*
    Invalid Input
    (.PDF or .Doc Formats Only)
  8. I agree to notify SIMCOL Group, LLC by certified mail of any changes in ownership or the legal status / structure of the aforementioned business.*
    Please agree to the terms
  18. PERTINENT INFORMATION AND REMARKS: IT IS VERY IMPORTANT THAT THE CREDIT OFFICE BE FURNISHED WITH ALL AVAILABLE FACTS THAT MAY ASSIST IN THE PROPER ANALYSIS OF THIS APPLICATION. I HEREBY AUTHORIZE SIMCOL GROUP, LLC TO CONTACT ALL BANKS AND TRADE REFERENCES FOR REQUIRED CREDIT INFORMATION NOW AND IN THE FUTURE.
  20. DIGITAL SIGNATURE:
  21. By entering your name and date below you are acknowledging that you are authorized filer of the Commercial Credit Application and that the information submitted is true and correct.
  23. Filers Name*
    Please insert Filers Name
  24. Filers Title*
    Please insert Filers Title
  25. Submission Date*
    Please select a date for application submission.
  26. SIMCOL Sales Consultant
    Please insert SIMCOL Sales Consultant
  28.   

Primary Contact

SIMCOL Petroleum Limited Company
3438 Peachtree Rd. NE, Suite 1475
Atlanta, Georgia 30326

678-954-4619 | Office
678-954-4627 | Fax
info@simcolgroup.com