WESTCO Consumer 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. 

W-9

WESTCO Credit Terms

 

I have read and agree to the Credit Terms above.
Consent *	No Yes
Application For *	Fuel/Auto/General Needs Heating Fuel Propane
If Propane: Tank Selection	Purchase WESTCO Tank I own my own Tank Lease WESTCO Tank N/A
If Propane: Tank Location
Street Address
City
State
Zip Code
Residence Info *	Own my property Rent
Landlord Name:
Landlord Phone:
Applicant Information
Name (First, MI, Last) *
Mailing Address: *
City *
State *
Zip Code *
Home Phone
Cell Phone *
Email *
S.S.N: *
D.O.B: *
Monthly Rent/Mortgage *
Bank Reference: *
Employment Information
Present Employer: *
Employer Phone: *
Years w/ Employer: *
Net Income/Month: *
Miscellaneous Information
Nearest Relative (not living w/ you): *
Relationship: *
Phone:
Credit accounts bill under 30-day terms. Propane customers may be eligible for our Annual Propane Budget Program which begins in June.
Are you interested in this program? *	Yes No
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? *	Yes No
Total cards needed:
Cards w/ same #/pin:
Cards w/ diff. #/pin:
Credit Authorization
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: *
Patronage Dividends
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.
eSignature:
Date:
* Required field

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