Besikoh Fuel LP – Cardlock Application Form

Fuel Card Application

Fill out the following application for Besikoh Fuel. By entering your name below, you certify the information you are entering is true.

Company Name
Applicants Name*
First Last
Address*
Street Address City Province Postal Code
Email*
Enter Email Confirm Email
Phone*
Business Type*
- Sole Proprietor
- Partnership
- Corporation
Number of Cards Required*
Card Users' Name(s)
Fuel Type Required
- Dyed Diesel
- Clear Diesel
- Regular Gasoline
- All Fuel Types
Names and Addresses of Individuals/Partners

Fill out this area if you are an individual or partner of a company.
Name of Person to Contact regarding Purchase Orders and Invoices.
Please include the title within the company of the contact person
Address
Street Address Address Line 2 City Province Postal Code

Include the contact's address
Bank References*

Include bank name, account number, a contact, title and phone number
Trade References*

Include company name, address, contact and title and phone number
I/We declare that the above information is true, correct and complete and is given to induce the Company to extend credit. We authorize the Company to make such credit investigation as the Company sees fit, including contacting the above trade references and banks and obtaining credit reports. We authorize all trade references, banks and credit reporting agencies to disclose to the Company any and all information concerning the financial and credit history of my company and myself:

IT IS AGREED AS FOLLOWS:

I/We agree to pay for all purchases upon receipt of monthly statement. Charges billed, but not paid within 30 days following the billing will be considered delinquent and subject to finance charges. Bi-Monthly statements are mailed on the first working day each month and the 15th day of the month. A service charge or finance charge of 2% is added to past-due balances that are not paid within 30 days following the billing.
Name
This field is for validation purposes and should be left unchanged.