WEX Request Form

2022 MEMBER DISCOUNT GAS PROGRAM
Savings:

$0.15 per gallon for the first 6 months (from the application approval date.)

The promotional rebate begins as soon as the application is approved, and is calculated based on the gallons purchased at any 76/ Phillips 66/ and Conoco fuel stations. The rebate is automated based on gallons purchased at 76/Phillips 66/ Conoco and will show as a credit on the customer’s monthly fuel invoice.

Waived $40 setup fee

Only $0.25 per month for card fees (normally $2.00 per card)
How this works:

1. Make sure your GCLA membership is current – you must be a 2022 member. If you are not, go online to www.gcla.org/join and sign up. Once your membership has processed, you will receive a member number. This number is what you will need to get accepted into the GCLA tire discount program. If you are already a member, use your member number to access this program on the form below.

2. Our fuel partner is WEX. As long as you are a GCLA member and accepted into this program, WEX will honor the above discounts to include a free set up fee that normally costs $40.00.

3. Fill out the form below. Your information will be verified through the GCLA. After that, you will receive a call from our fuel partners at WEX.
Full Name*

First NameLast Name
Company*
E-mail*
Phone*
GCLA Membership Number*
(The number on your certificate of membership.)
Vehicle Type

SedanSUVVanShuttle BusMidsized BusFull Size Bus/Motor Coach
Any additional comments
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2022 MEMBER DISCOUNT GAS PROGRAM