forms

                                                                       ACCOUNT APPLICATION
Please read the following before completing this form:
Applicant represents that the information given in this application is complete and accurate and authorizes Walsma Oil Co. to
check with credit reporting agencies, credit references and other sources disclosed to confirm information given.
Applicant requests a commercial/personal charge account if approved for credit. Please note that a signed credit application
must be received prior to receipt of product.

      NOTE: You may complete this application, print, sign and fax to: Walsma Oil Company at (661) 723-0116

Please mail original signed application to: Walsma Oil Company
                                                                    44141 N. Yucca Avenue
                                                                    P.O. BOX 17
                                                                    Lancaster, CA 93534

If you have any questions regarding the completion of this application, please call (661) 945-4772 or (661) 942-3637

To access application, please click on apply button.