WESTCO Commercial Credit Application & Agreement

All fields are required to fully complete application.

After completing application, please email a photocopy of the applicant's state driver's license to credit@westco.coop. If applicant elects to receive Patronage Dividends, please download the IRS W-9 form below, and email to credit@westco.coop


WESTCO Credit Terms

Company Name: *
Mailing Address: *
City, State, Zip: *
Business Phone: *
EIN/Fed. Tax ID: *
Principal Officer: *
Cell Phone: *
Email: *
D.O.B: *
S.S.N.: *
Type of Business: *
If "Other" please describe:
Brief description of business: *
Years in Business: *
Business Website:
Is business located here temporarily? *
If yes, how long will you be in the area?:
Bank: *
Loan Officer:
Bank Phone #: *
Loan Officer Phone/email:
Supplier Ref. 1: *
Supplier Ref. 1 Phone: *
Supplier Ref. 2: *
Supplier Ref. 2 Phone: *
Products/Services Needed: * Propane
Bulk Fuel
General Needs
If Propane: Tank Selection
If Propane: Tank Location (Address, City, State, Zip)
WESTCO Charge Cards are only needed if you plan to use your WESTCO Account at our C-Stores or 24-hour fuel locations. All charges will go under one account; however, on your statement you can see the card number of the purchaser, giving you the ability to split our charges if needed.
Will you need WESTCO charge cards? *
Total cards needed:
Cards w/ same #/pin:
Cards w/ diff. #/pin:
The information provided on this application is correct and complete. I hereby authorize Western Cooperative Company (DBA WESTCO) to conduct a credit investigation, including contact of my bank reference to support information I have provided. I also agree to abide by WESTCO's credit terms, which I have reviewed:
eSignature: *
Date: *
Personal Guarantor Signature: *
Date: *
As a patron of Western Cooperative Company, I hereby consent and agree that the amount of any distributions with respect to patronage occurring on or after Oct. 1, 1963, which are made in written notices of allocation as defined in 26 U.S.C. 1388, and I receive from the Cooperative, will be into my accounts at their stated dollar amount in a manner provided in 26 U.S.C 1385(a) in the taxable year in which I receive such written notices of allocation. ** Receiving Patronage is optional. If receiving patronage, please sign. This will require you to submit a completed W-9 Form, which can be found on this page and emailed to credit@westco.coop.
Credit accounts bill under 30-day terms
* Required field

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