Commercial Fueling 24/7 Credit Application

In order to receive a business account with Commercial Fueling 24/7, you must fill out the form below to apply for credit.  You will receive an email confirmation at the email address you provide and a representative will contact you shortly.

1 - Business Information
Company Name
 Fed ID # or Social Security #
 
Type of Business
 Date Established (mm/dd/yyyy)
Business Address
 Business Address 2 (optional)
City
State
   Zip Code
   
Business Phone (10 digits)
 Business Fax (10 digits)
Cell Phone (10 digits. optional)
  
Delivery Address

 Delivery Phone (10 digits)
Billing Address

  Accounts Payable Office
Contact Email Address
 Confirm Email Address
Number of Diesel Vehicles
 Number of Gasoline Vehicles
Number of Other Vehicles
 Description of Other Vehicles (optional)

2 - Credit References - Open Accounts (Credit Accounts)
Reference 1 Name
 Reference 1 Address
Reference 1 Phone (10 digits)
 Reference 1 Business Fax (10 digits)
Reference 2 Name
 Reference 2 Address
Reference 2 Phone (10 digits)
 Reference 2 Business Fax (10 digits)
Reference 3 Name
 Reference 3 Address
Reference 3 Phone (10 digits)
 Reference 3 Business Fax (10 digits)
Has the applicant or any of it's owners, principals, officers, or directors ever filed a voluntary petition ib bankruptcy, been adjudged bankrupt, or made an assignment for the benefit of creditors?

3 - Principal Officer / Partner Information
Principal Officer Name
 Principal Officer Address
Social Security # (Required format xxx-xx-xxxx)
    		 
Partner Name
 Partner Address
Social Security # (Required format xxx-xx-xxxx)
    		 

4 - Current Fuel Supplier
Name
 Address
Contact
 Phone (10 digits)
Fax (10 digits. optional)
 Account Number (optional)

5 - Comments

Please provide any additional comments or questions (optional).

6 - Credit Policy and Terms

  1. A LATE CHARGE will be assessed on all balances over thirty (30) days. This is computed by a periodic rate of 1.5% (which is an annual percentage of 18%) on the portion of the previous balance over thirty (30) days less payments and credits appearing on the statement. An account is considered past due when a late payment charged is assessed. Any account, which becomes past due, is subject to terminiation of automatic fuel delivery without notice until the account balance is paid in full.
  2. Any account turned over to a collection agency or attorney will be charged with the cost of collection.
  3. A service charge of $20.00 will be assedd on any check returned by a bank.

I certify that the information in this application is true and accurate and is submitted to Commercial Fueling 24/7 in conjunction with a request for credit. References listed are authorized to release any credit information to Commercial Fueling 24/7. A copy of this authorization shall be as valid as the original.

I hereby authorize Commercial Fueling 24/7 to make whatever credit investigations they may deem appropriate and to exchange any information they may receive in the course of such investigations. A copy of this authorization shall be as valid as the original.

Personal Guaranty

In consideration for the extension of charge card rights for the purchase or services to the applicant, THE UNDERSIGNED PERSONALLY GUARANTEES THE UNCONDITIONAL PAYMENT OF ANY UNPAID AMOUNT UPON THE APPLICANT'S ACCOUNT. This is a guarantee of payment and not merely of collection; no collection or civil action need to be commenced against the Applicant prior to a demand being made upon the undersigned. A comply of this guarantee shall be as valid as the original.