Applications

Schedule an Appointment

Contact Information










StateRhode IslandMassachusettsConnecticut

Vehicle Information





Have We Serviced this vehicle Before? (required)YesNoUnsure
Service Appointment Information


Preferred Method of Contact (required)EmailPhone
Service Type (check all that apply)
Scheduled ServiceMaintenanceA/C or heatingBatteryBelts or HosesBrakesCooling SystemCharging SystemDrive TrainEmissionsExhaustFluidsLightingSteeringSuspensionTiresTransmissionOther (please describe in comments)
Comments

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Credit Application

Billing Address


Delivery Address (if different from billing)



Do you (required):
OwnRent
Is the Building (required):
CommercialRecidential



Type of Organization (required):
PropiertorshipPartnershipCorporationTrustOther


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


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


Bank Credit At:

Principles (at least 1 required)

(fill in Name, Address & Telephone for each)

Supplier References

(fill in Name, Address & Telephone for each)




In Consideration of FLEET MASTER and/or subsidiaries selling to me or to my agent(s), I agree to the following items:

• To pay the monthly statement in full within the billing cycle.
• 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.
• 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.
• 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)

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Company Name

Email

Address

Gallon Limit (please select one)
10 Gallons20 Gallons30 Gallons40 Gallons50 Gallons75 Gallons150 Gallons250 Gallons500 Gallons999 Gallons

Entry Type (please select one)
Pin Number OnlyPin Number and OdometerPin Number and Manual EntryPin Number, Odometer and Manual Entry

Product Type: (please select one)
All ProductsRegular Unleaded OnlyUnleaded OnlyDiesel OnlyBio-DieselAll Gasoline Products

Billing Cycle (please select one)
WeeklyBi-Weekly