FLEET SERVICES APPLICATION

FLEET SERVICES APPLICATION
TELL US ABOUT YOUR BUSINESS
Do you have an existing account?
No
Yes Account #
What is your company’s legal name?
If applicable, what is your DBA?
What is your Federal Taxpayer ID #? (EIN,TIN, or SSN)
DUNS#
Is your business exempt from motor fuel tax?
Yes (Please attach tax exemption certificate.)
Physical Address – City, State, Zip (No PO Boxes)
Billing Address – City, State, Zip
Number of years in business?
Annual Sales?
No
Number of Employees?
Is your company a
Corporation
Limited Liability Corporation
Type of business?
Agriculture
Service
Construction
Transportation
1
Partnership
1
Finance
Government
Wholesale Trade
Primary phone number††
Sole Proprietorship1
Non-Profit
Government Agency
Manufacturing
Mining
Non-Profit
Retail Trade
Other _________________________________________
Fax number
Primary bank reference
Address, City, State, Zip
Phone number
Name of a trade reference
Address, City, State, Zip
Phone number
Name of a trade reference
Address, City, State, Zip
Phone number
TELL US HOW YOU WOULD LIKE TO MANAGE YOUR ACCOUNT
Name of your company as it should appear on your cards (Note: There is a 25 character limit)
Account type desired o Fleet o Commercial How would you like to receive your billing statement? o online o paper (a fee may apply)
Primary Contact Name
Primary Contact Title
Phone number††
TELL US ABOUT YOURSELF
E-mail address††
# of Cards
Requested Monthly Credit Limit $
Name of Company Principal(s) ________________________________ Title of Company Principal ________________________________
Social Security Number
Date of Birth
To help the US government fight terrorism and money laundering, federal law requires us to obtain, verify, and record information that identifies each
company or person who opens an account. What this means for you: When you open an account, we will ask for your name, street address, date of
birth, and an identification number (such as a social security number) that will allow us to identify you. We may ask to see your driver’s license or other
identifying documents that will allow us to identify you or your business.
Title _________________________________________________
Account owner
Authorized officer/principal
Authorized representative
Authorized Signature
Date
You understand you are submitting a request for a Valero® Fleet Services Credit Card account, and if approved for credit, one or more Valero® Fleet Card(s). You understand Valero®
will provide your company with a Valero® Fleet Services Credit Card Agreement and other details regarding the use of the Valero® Fleet Services Credit Card Program.** (See
important information on the next page.) You have authority to represent this company and provide information for this application. You represent the information given is complete
and accurate and authorize Valero® to check with credit reporting agencies, credit references, and other sources disclosed to confirm information given in this application about the
business and to obtain credit reports or other information about the individual(s) identified above.
1
If you are a Sole Proprietorship or Partnership we require your Personal Guaranty as a condition of extending credit. If you are a Limited Liability Company, or if your business has
been incorporated for less than three years, we may require your Personal Guaranty as a condition of extending credit. If you agree to unconditionally and personally guarantee any
account issued as a result of this application, you understand that we may make credit inquiries and furnish information about you, personally, to credit reporting agencies/bureaus
or in response to credit inquiries from others. (New York residents: If you ask, you will be informed whether or not such a report was obtained and, if so, the name and address of the
agency that furnished the report.) Late payments, missed payments, or other defaults on your account may be reflected in your personal credit report. If your application is denied
based on your personal consumer credit report, we will provide you with the agency/bureau information.
To the extent allowed by law, we may share information disclosed by or generated as a result of this application with our affiliates and with merchants that accept the card. In
addition, information regarding your transactions may be provided to accepting merchants or their service providers to facilitate discounts or other promotional campaigns of
interest to you.
††
You agree that we may contact you at any one of the phone numbers you have provided. You also agree to receive calls and messages such as, pre-recorded messages, calls and
messages from automated dialing systems, or text messages. Cell phone charges may apply. We may use your email address to contact you about your account
VFSA-B 07/15