Complete Business Name Street Address City State Zip Code Phone Fax Email Address How long in business Federal ID Nature of Business Accounts Payable Contact Phone Trade References list three O ID: 124234
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MOISTEN TO SEAL Complete Business Name Street Address City State Zip Code Phone Fax Email Address How long in business? Federal I.D. # Nature of Business Accounts Payable Contact Phone Trade References (list three) Owners, Partners & Directors Name Address City State Zip Code Phone Cell Phone Social Security Number Email Name Address City State Zip Code Phone Cell Phone Social Security Number Email Statement Options - Select method of delivery for invoices 1. Email Delivery Email Address Contact 2. Fax Delivery Fax Number Contact Current Audited Financial Statements Attached or Faxed (to 330-804-9140) Credit Terms & Conditions Authorized Signature Date Printed Name Title Fuel Mart, division of Ports Petroleum Company, Inc., Wooster, OH Visit us online www.fuelmart.com • Select vehicle options on reverse side Check one: Corporation Partnership Proprietorship returned to Ports upon demand. ∙This card is a charge card and not a credit card. Applicant shall pay to Ports the full amount due as shown upon receiving the statement. ∙Any account which is not paid in full by the subsequent statement date shall be deemed delinquent. Delinquent accounts may be assessed a finance charge of up to one and one half percent per month or eighteen (18) percent annually, on the ∙Either Ports or applicant may cancel this card by either demanding return of the card or the surrender of the card. ∙Ports may, at its option, elect to change the terms and conditions hereto. If such election is made, Ports shall notify, in writing, all card users of such election and the content thereof. After thirty (30) days of such notice, such change shall be binding upon all charge card holders. ∙The applicant agrees to pay all costs and expenses of collecting delinquent accounts, including (but not limited to) reasonable attorney's fees, incurred by Ports Petroleum Company, Inc. 1-800-562-0373 • Fax 330-264-5876 For your convenience in-store/on-site cards can be made available at location NO TRANSACTION FEES NO SET UP OR ANNUAL FEE Commercial Card Application Company City/State Phone