Initial here if you would like all payments applied to the oldest invoices on the account (for COD& personal credit only.)

I acknowledge all deposits and/or refunds will be issued by check, regardless of the original form of payment, and will be made payable to the order of the “Applicant Name or Business Name” listed on page 1 of this application. No Exceptions.

I acknowledge that all cylinders and dry ice bins will be subject to daily rent and any unpaid balance will be deducted from my deposit.

Short-Term Accounts (Available at Eureka Oxygen ONLY): I acknowledge and agree to pay $1.00 per day, per item for each day after seven (7) days at no charge.

Personal Guarantee

MUST Be Completed To Be Considered For All Account Types (COD/Short-Term, Personal Credit & Business Credit) Authorization is hereby granted to Eureka Oxygen Company, Inc. to obtain a standard factual data credit report through a credit reporting agency chosen by Eureka Oxygen Company, Inc. My signature below authorizes the release to the credit reporting agency a copy of my credit application and authorizes the credit reporting agency to obtain information regarding my employment, savings accounts, and outstanding credit accounts (mortgages, auto loans, personal loans, charge cards, credit unions, etc.). Authorization is further granted to the reporting agency to use a photostatic reproduction of this authorization, if necessary, to obtain any information regarding the above-mentioned information. Under the Fair Credit Reporting Act, applicant/s have a right to know and to receive a free copy of the information contained in their credit file at the consumer reporting agency. If credit is denied, applicant/s may request a copy, in writing, no later than 60 days after they receive a notification. In consideration of credit being extended by Eureka Oxygen Company DBA: Ukiah Oxygen, Petaluma Oxygen & Lake County Welders Supply to the above named applicant for merchandise to be purchased whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation, or other entity, the undersigned guarantor or guarantors each hereby contract and guarantee to Eureka Oxygen Company the faithful payment, when due, of all accounts of said applicant including applicant’s authorized agent(s) and or employees for purchases made on behalf of applicant as of the date of this application. The undersigned guarantor or guarantors each hereby express waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment, and demand for payment on applicant, protest and notice to undersigned guarantor or guarantors of dishonor or default by applicant or with respect to any security held by Eureka Oxygen Company, extension of time of payment to applicant, acceptance of partial payment or partial compromise, all other notices to which the undersigned guarantor or guarantors might otherwise be entitled and demand for payment under this guarantee. Any revocation of this guarantee shall be in writing and delivered to Eureka Oxygen Company. This Personal Guarantee can only be modified in writing and signed by both parties. Applicant agrees to pay any collection cost incurred to collect the unpaid balance, including but not limited to interest on the unpaid balance as allowed by the state law and any reasonable attorney fees incurred. The undersigned as an inducement to grant credit warrants that the information submitted is true and correct. Eureka Oxygen Company is authorized to investigate the credit references and verify the applicant information as listed above. By signing below, applicant declares that the foregoing information is true and correct. Upon acceptance of credit being extended, applicant will be entered into the above personal guarantee contract. Payment history may or may not at some time be reported to a credit bureau. Applicant agrees to pay for purchases in accordance with account billing terms of net 30 days (balance on account due in full 30 days from purchase date) and further agree to pay service charges of 1½% per month (18% annually) on balances not paid within billing terms. If you have any questions regarding our personal guarantee policy, please call our office at (707) 443-2228.

(COD & PERSONAL ACCOUNTS ONLY): I agree that all payments made to my account will automatically be applied to the oldest amounts due on my account first. OPTIONAL:

I acknowledge all deposits and/or refunds will be issued by check, regardless of the original form of payment, and will be made payable to the order of the “Applicant Name or Business Name” listed on page 1 of this application. No Exceptions.

I acknowledge that all cylinders and dry ice bins will be subject to daily rent and any unpaid balance will be deducted from my deposit.

Short-Term Accounts (Available at Eureka Oxygen ONLY): I acknowledge and agree to pay $1.00 per day, per item for each day after seven (7) days at no charge.

Personal Guarantee

MUST Be Completed To Be Considered For All Account Types (COD/Short-Term, Personal Credit & Business Credit) Authorization is hereby granted to Eureka Oxygen Company, Inc. to obtain a standard factual data credit report through a credit reporting agency chosen by Eureka Oxygen Company, Inc. My signature below authorizes the release to the credit reporting agency a copy of my credit application, and authorizes the credit reporting agency to obtain information regarding my employment, savings accounts, and outstanding credit accounts (mortgages, auto loans, personal loans, charge cards, credit unions, etc.). Authorization is further granted to the reporting agency to use a photo static reproduction of this authorization, if necessary, to obtain any information regarding the above mentioned information. Under the Fair Credit Reporting Act, applicant/s have a right to know and to receive a free copy of the information contained in their credit file at the consumer reporting agency. If credit is denied, applicant/s may request a copy, in writing, no later than 60 days after they receive notification. In consideration of credit being extended by Eureka Oxygen Company DBA: Ukiah Oxygen, Petaluma Oxygen & Lake County Welders Supply to the above named applicant for merchandise to be purchased whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation, or other entity, the undersigned guarantor or guarantors each hereby contract and guarantee to Eureka Oxygen Company the faithful payment, when due, of all accounts of said applicant including applicant’s authorized agent(s) and or employees for purchases made on behalf of applicant as of the date of this application. The undersigned guarantor or guarantors each hereby express waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment, and demand for payment on applicant, protest and notice to undersigned guarantor or guarantors of dishonor or default by applicant or with respect to any security held by Eureka Oxygen Company, extension of time of payment to applicant, acceptance of partial payment or partial compromise, all other notices to which the undersigned guarantor or guarantors might otherwise be entitled and demand for payment under this guarantee. Any revocation of this guarantee shall be in writing and delivered to Eureka Oxygen Company. This Personal Guarantee can only be modified in writing and signed by both parties. Applicant agrees to pay any collection cost incurred to collect the unpaid balance, including but not limited to interest on the unpaid balance as allowed by the state law and any reasonable attorney fees incurred. The undersigned as an inducement to grant credit warrants that the information submitted is true and correct. Eureka Oxygen Company is authorized to investigate the credit references and verify the applicant information as listed above. By signing below, applicant declares that the foregoing information is true and correct. Upon acceptance of credit being extended, applicant will be entered into the above personal guarantee contract. Payment history may or may not at some time be reported to a credit bureau. Applicant agrees to pay for purchases in accordance with account billing terms of net 30 days (balance on account due in full 30 days from purchase date) and further agree to pay service charges of 1½% per month (18% annually) on balances not paid within billing terms. If you have any questions regarding our personal guarantee policy, please call our office at (707) 443-2228.