Credit Application – Northern Natural Gas

Shipper Information

Shipper Name

Street Address

PO Box

City

Country

State/Province

Zip Code

Phone Number

Fax Number

Email Address

Type of Business

Corporation Partnership Individual Limited Partnership Closely Held Corporation Trust

State/Province Incorporated in

Years in business

Shipper Information (Continued)

Has customer changed its name in the last 5 years?

Yes No

If yes, furnish prior name and address.

Name

Street Address

PO Box

City

Country

State/Province

Zip Code

Principal Owners, Stockholders, Partners, or Officers

List the three principal owners, stockholders, partners, or officers. The first owner is required; the others are optional and can be added by expanding their panel.

Owner 1 Required

Name

Title

Street Address

PO Box

City

Country

State/Province

Zip Code

Phone Number

Owner 2 Optional

Name

Title

Street Address

PO Box

City

Country

State/Province

Zip Code

Phone Number

Owner 3 Optional

Name

Title

Street Address

PO Box

City

Country

State/Province

Zip Code

Phone Number

If a wholly owned subsidiary, name and address of parent

Name

Title

Street Address

PO Box

City

Country

State/Province

Zip Code

Phone Number

Is parent Company responsible for subs debts?

Yes No

Billing Address

Street Address

PO Box

City

Country

State/Province

Zip Code

Phone Number

Amount Of Credit Requested ($)

References

Please furnish two(2) bank references

Business Name

Street Address

PO Box

City

Country

State/Province

Zip Code

Contact

Phone Number

Business Name

Street Address

PO Box

City

Country

State/Province

Zip Code

Contact

Phone Number

References (Continued)

Please furnish four(4) business credit references

Reference #1 Required

Business Name

Street Address

PO Box

City

Country

State/Province

Zip Code

Contact

Phone Number

Reference #2 Optional

Business Name

Street Address

PO Box

City

Country

State/Province

Zip Code

Contact

Phone Number

Reference #3 Optional

Business Name

Street Address

PO Box

City

Country

State/Province

Zip Code

Contact

Phone Number

Reference #4 Optional

Business Name

Street Address

PO Box

City

Country

State/Province

Zip Code

Contact

Phone Number

Submit Credit Application

Attach copies of your financial statements (to include, at least, the three most recent years on an annual basis and the three most recent monthly or quarterly statements.)
If credit is approved, payment terms are as set forth in Northern’s FERC Gas Tariff (Tariff) which can be found on Northern’s web site. Invoices not paid within these terms may result in customer being required to pay for service in advance and/or having service suspended until the entire balance due is paid.
Northern reserves the right to limit or revoke the amount of credit extended to a customer. Northern reserves the right to require security as set forth in its Tariff which may include a guaranty, an irrevocable letter of credit, or cash, before entering into a service agreement or continuing service to a customer. You will be notified if such an instrument is required. To avoid delays be sure your credit is approved before requests for service are made and/or any service is scheduled.
Information provided on this application will be held in strictest confidence and used only by the Company, or its affiliates, in making a credit evaluation. Provided, however, information provided through this form is not encrypted. Northern is not responsible for any misuse of the information resulting from unauthorized access during transmission to Northern. Customer may fax the required information to Northern at (402) 548-5280.

Company

Signature or Contact Name

Title

Date

Please submit attachments to credit@nngco.com