Credit Application

Sales Tax Permit Number:

Applicant's Name (required):

Applicant's Email (required):

If Proprietorship, include alias DBA:

Billing Address

Address Line 1 (required):

Address Line 2 (required):

Delivery Address (if different from billing)

Address Line 1:

Address Line 2:

Business Phone (required):

Do you (required):

Is the Building (required):

Amount of Credit Requested (required):

Property Manager's Phone:

Name of Parent Company (if subsidiary):

Type of Organization (required):

Type of Business (required):

In Business Since (year, required):

Checking Account(s) at (at least 1 required)

Account 1:

Account 2:

Account(s) in the Name of (required):

Account 1:

Account 2:

Bank Credit At:

Bank 1:

Bank 2:

Bank Account Officer:

Principles (at least 1 required)

(fill in Name, Address & Telephone for each)

Principle 1:

Principle 2:

Principle 3:

Principle 4:

Supplier References

(fill in Name, Address & Telephone for each)

Supplier 1:

Supplier 2:

Supplier 3:

Supplier 4:

In Consideration of FLEET MASTER and/or subsidiaries selling to me or to my agent(s), I agree to the following items:
1. To pay the monthly statement in full within the billing cycle.
2. In the event of default of the foregoing paragraph (1), I agree to pay a monthly finance charge of 1.5% added monthly on any unpaid balance past due. THIS FINANCE CHARGE RATE EQUALS 18% PER ANNUM. In addition, any volume/prompt payment gallonage discount would be forfeited.
3. If this account is placed in the hands of an attorney for collection, I agree to pay all reasonable charges for collection including attorney's fees, and further agree that a charge of 3% of the amount shall be considered reasonable as attorney's fees.
4. If submitting electronically, I substitute an electronic signature in place of a physical signature. Additional paperwork and/or signatures may be required before final approval. Additional references and/or documentation may also be requested by Fleet Master for verification purposes.

I have read and agree to the terms and conditions listed above (required to submit application)

Date (required):

Signature of Applicant (required):

Prove you are not a robot