CITGOFleet CREDIT CARD APPLICATION
P.O. Box 29180, Shawnee Mission, KS 66201-9180 FAX: 913/677-8730
Please retain original application if transmitted to CITGO by FAX.
Complete application in full.
BILLING TYPE: F Standard - No Fee F Enhanced - $0 - $5 per month (See schedule below)
CREDIT CARD APPLICATION (Please Type or Print Clearly)
BUSINESS NAME
PREFERRED BUSINESS NAME, TRADING NAME OR DBA NAME TO APPEAR ON CREDIT CARD
STREET ADDRESS (PLEASE PROVIDE FULL STREET ADDRESS INCLUDING ZIP IF DIFFERENT THAN MAILING ADDRESS)
BELOW)
MAILING ADDRESS
CITY/TOWN STATE
ZIP CODE
ALTERNATE PHONE IF FIRST IS A RECORDER
BUSINESS AREA CODE & PHONE NO. OR ANSWERING SERVICE FAX NO.
(
)
(
)
(
)
YEARS IN BUSINESS
UNDER
PRESENT OWNERSHIP
COMPANY ANNUAL
SALES VOLUME $
NO. OF EMPLOYEES
EXCLUDING OWNER
TYPE OF BUSINESS:
SOLE PROPRIETORSHIP
PARTNERSHIP
PRIVATE CORP.
LIMITED LIABILITY PARTNERSHIP
LIMITED LIABILITY COMPANY
PUBLIC CORP.
DATE OF INC. FED. I.D. NO.
TAX EXEMPT
*REQUIRES
EXEMPTION
CERTIFICATE
NATURE OF BUSINESS SERVICES
COMPANY WEB SITE ADDRESS
SPECIFY IF ABOVE COMPANY IS:
FRANCHISE
DIVISION
BRANCH
SUBSIDIARY
LIST NAME AND LOCATION OF HEADQUARTERS AND/OR PARENT FIRM
PRIMARY CONTACT'S NAME
POSITION/TITLE
AREA CODE & TELEPHONE
( )
E-MAIL ADDRESS
SECONDARY CONTACT'S NAME
POSITION/TITLE
AREA CODE & TELEPHONE
( )
E-MAIL ADDRESS
NAME AND RESIDENCE ADDRESS OF OWNER, PARTNERS OR OFFICERS (Also Include Personal CITGO Account, if any)
NAME 1
2
3