New Client Onboarding Form

BILLING INFORMATION

Account Name

Attn:

Address:

City/State/Zip:

Phone:

Email:

SHIPPING INFORMATION: Only if different than Billing Info.

Account Name

Attn:

Address:

City/State/Zip:

Phone:

Email:

FINANCE INFO

Federal Tax ID #:

Preferred Payment Method:
—Please choose an option—CreditACHCredit Card

Total Credit Line Desired (if applicable):

PO Required:
Yes

Tax Exempt:
Yes

If yes, please upload tax exempt certificate from.

CONDITIONS FOR CREDIT CARD PAYMENTS

A FEE OF 3.5% WILL BE ADDED TO ALL INVOICES FOR CREDIT CARD PAYMENTS.

CONDITIONS FOR THE EXTENSION OF CREDIT

FOR THE PURPOSES OF OBTAINING AN EXTENSION OF CREDIT, I (WE) (“Applicant”) STATE THAT ALL OF INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT. THE PARTIES HEREBY AGREE THAT SERVICES ARE RENDERED SUBJECT TO THE FOLLOWING TERMS AND CONDITIONS:

1. All invoices are due and payable on Net 15-day terms. A NSF charge of $25.00 and a Handling Fee off $25.00 shall be assessed for return checks.

2. If any collection action is undertaken, Fuel Merchandise Group, shall be entitled to recover a reasonable attorneys’ fee, all attendant collection costs, all court costs, and all legal interest accrued on past due principal amounts.

3. Amounts past due are subject to 1.5% (or highest rate allowed by law) each month (18% per annum) until the balance is paid in full.

ADDITIONAL AUTHORIZED PURCHASING PERSONNEL: If applicable.

Name:

Title:

Address:

City/State/Zip:

Phone:

Email:

ADDITIONAL AUTHORIZED PURCHASING PERSONNEL: If applicable.

Name:

Title:

Address:

City/State/Zip:

Phone:

Email:

ADDITIONAL AUTHORIZED PURCHASING PERSONNEL: If applicable.

Name

Title

Address:

City/State/Zip:

Phone:

Email:

ADDITIONAL AUTHORIZED PURCHASING PERSONNEL: If applicable.

Name

Title

Address:

City/State/Zip:

Phone:

Email: