Flying J Gas Credit Card Application Form

To avail of the credit card issued by Flying J Gas, applicant must fulfill and submit this form. Once application is approved, customer will gain access to a monthly gas allowance that can be purchased on credit. Payments will be collected every end of the month.Download

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FLEET FUEL CARD
CREDIT APPLICATION FORM	 	
Applicant hereby requests and authorizes all references to release credit information to SFJ, and authorizes a credit report for any corporation, corporate of cer, partner, or owner to be issued to SFJ.  By signing, applicant authorizes SFJ to process or otherwise manage credit transaction information in any matter deemed appropriate by SFJ.  Applicant hereby agrees to be bound by all terms, conditions, and agreements governing credit application and Credit Agreement, as amended from time to time.  Applicant understands that applicant may be required to furnish SFJ a personal guarantee, a letter of credit,\
 or other security in an amount designated by SFJ to secure applicant’\
s line of credit with SFJ.
Signature of Authorized Signer      Title      Print Name        Date	
The Fuel Card for Flexible Control over Driver Expenses
Phone: 800.661.2278 ex. 6603	Fax: 801.395.8662	
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COMPANY INFORMATION
Legal Business Name 	  ________________________________________________________________________\
____________________________________________________________________	
Physical Address 	 ______________________________________________________________	Cit y	 _______________________	Province	 __________________	Postal Code	 ___________________	
Customer Mailing Address 	  ______________________________________________________	Cit y	 _______________________	Province	 __________________	Postal Code	 ___________________	
Primar y Contact Person 	  ________________________________________________________________________\
__________________________________________________________________	
Telephone (                 ) 	  _____________________________________	Cellular (                 ) 	 _______________________________________	Fa x  (                 )  	 ______________________________	
Email 	________________________________________________________________________\
________________________________________________________________________\
__________	
Years in business 	 ______________________	Nature of business 	  ________________________________________________________________________\
_________________________________	
Organization Type: 	  Proprietorship    	  Par tnership   	  Owner/Operator 	   LLC 	   Corporation    	   Other	 ___________________________________________________	
Parent Corporation (if subsidiar y) 	  ________________________________________________________________________\
____	 Language Preference  	  Engilsh 	  French	
COMPANY REPRESENTATIVES 
(of cers, partners, principals, or proprietor)
Title	 ________________________________________________________________________\
_	
Name	 ________________________________________________________________________\
	
Telephone (            ) 	 __________________________	SIN	 ______________________________	
Date of Bir th 	 ____________________________	Province	 ______________________________	
Fleet Manager
Title	 _________________________	Name 	  __________________________________________	
Email 	________________________________________________________________________\
	
Telephone (            )	  ____________________________________________________________	
Accounts Payable
Title	 _________________________	Name 	  __________________________________________	
Email 	________________________________________________________________________\
	
Telephone (            )	  ____________________________________________________________	
(if different from above)	
CREDIT INFORMATION
1.  Submit  nancial statements. Financial statements are necessar y for companies who require 
a credit line of more than $7,500. 
2.  Complete and return the Personal Guarantee Agreement.
3.  Estimated monthly fuel purchases from all suppliers:  $ 	  _____________________________	
4.  Are you ta x exempt? (Con rmation is required) 	  Yes 	  No	
BANK AND TRADE REFERENCES
Please provide your current banking and supplier details
Bank Name 	 ____________________________________________________________________	
Account Number	 ________________________________________________________________	
Contact 	 _______________________________________________________________________	
Telephone Number (             ) 	  _____________________________________________________	
Fa x Number (             )	  ___________________________________________________________	
Current Fuel Card Supplier
Supplier Name	  _________________________________________________________________	
Account Number 	  _______________________________________________________________	
Contact Name 	  _________________________________________________________________	
Telephone Number (             )	 ______________________________________________________	
PAYMENT METHOD & TERMS OPTION 
(Mark one method and one terms option)
Security Deposit 
Security deposit must be amount of credit line needed.
Deposit amount:  USD	  _________________________	CAD	 ______________________________	
METHOD	   	 PAD*   	TERMS  	  Daily   	  Bank Wire     	  Twice Weekly 	
       	  Weekly	
I hereby give authorization to SFJ Inc to draft a security deposit on (date)_________   initial	  ___________	
Draw Down
Prepay in advance. USD only— 	Initial deposit required to establish account	
  Bank Wire 	   Western Union 	  TAB Book Transfer	
Letter of CreditLetter of credit is subject to credit approval (requires TCH format)
Deposit amount:  USD	  _________________________	CAD	 ______________________________	
METHOD	   	 PAD*   	TERMS  	  Daily   	  Bank Wire     	  Twice Weekly	
       	  Weekly	
Open Line of Credit
Line of credit is subject to credit approval.
Credit line:   USD	 ______________________________	CAD	 ______________________________	
METHOD	   	 PAD*   	TERMS  	  Daily   	  Bank Wire     	  Twice Weekly	
      	  Weekly	
* PAD is a pre-authorized draft and requires completion of the EFT form	
Quoted transaction fee 	$  _________	
ACCOUNT SETUP
Total Number of Company Vehicles: 	 ______	Total Number of Owner/Operator Vehicles: 	 ______	
Number of Cards Desired:	  _________	Quantit y of Cheques Desired:(USD)	 _________________	
Marked Fuel Required (cer ti cate will be required):   	  Yes   	  No 	
Additional Card Embossing Requested:   	  Yes    	  No 	
(Your business name is automatically embossed on the  rst line of each card. However, if you still want to emboss your business cards beyond your business name, a customer ser vice rep will call you to assist you in your embossing needs.)