Supreme Oil

Payment Authorization Form

**Please note: the following information must be completed before your request to become a customer will be processed.

PAYMENT AUTHORIZATION: Customer authorizes Supreme Oil to initiate credit and debit entries to/from Customer’s stated account indicated above for amounts owed on invoices or statements that are provided to Customer and Customer hereby authorizes the financial institution named above (the “Institution”), to accept the credit and debit entries. Authority to initiate credit and debit entries shall remain in full force and effect until Supreme Oil has received written notice from Customer 30 days in advance of its termination of such authorization. Customer understands that Customer has the legal right to stop payment of a credit or debit entry by notification to Institution; provided, prior to such action, Customer shall give Supreme Oil 30 days written notice to permit Supreme Oil to take any necessary actions to avoid disruptions in payments from Customer. WE DO NOT ACCEPT CHECKS or DEBIT CARDS, WE ONLY ACCEPT CREDIT CARDS.

For all billing questions, the office is available M-F during work hours 8am-5pm. After hours are for EMERGENCY only. Due to high volume of calls and limited staff, please leave a voice mail, e-mail or text and we will reply in a timely manner. If you need immediate access to your account, please log-in to your account via the Supreme website to view the delivery history, balance due or to make payment.