P66 Enrollment Form

P66 Enrollment Form
GENERAL INFORMATION
Legal Business Name*
Doing Business as Name
ICAO/IATA
Contact Name*
Phone Number*
Please enter a valid phone number.
Extension
Mobile Number
Please enter a valid phone number.
Email
example@example.com
YesNo
YesNo
YesNo
PHYSICAL ADDRESS
Physical Address Line 1*
Physical Address Line 2
City
State
Zip Code*
YesNo
BILLING ADDRESS
Billing Address Line 1*
Billing Address Line 2
City
State
Zip Code*
Phone Number
Please enter a valid phone number.
YesNo
Marketing Company?
SOFTWARE ORDER FORM

Licensee agrees to license the following World Fuel proprietary software in accordance with the terms and conditions of the Agreement:
YesNo
What is your Client Identifier?
Upon completion of this form, your existing account will be migrated to a P66 account within 5 business days. At that time, you will be required to utilize the updated encrypted card swiper to complete all card transactions. This swiper will be shipped to you within 2 business days of completion of this form. Swiper options are listed below.
P66 AvPOSP66 Total Aviation Software (AvPOS + Fuel / Concierge Module)
You have indicated that you would like to utilize the AvPOS software option. This option carries a recurring charge of $30 per month.
You have indicated that you would like to utilize the Total Aviation Software option. This option has a recurring charge related to the fuel equipment costs selected below.
1 to 5 pieces = $430 per month6 to 10 = $530 per month11 to 15 pieces = $655 per month16 to 20 pieces = $805 per month
Sum
Based on your selection above, your recurring fee would be ${sum} per month.
Credit CardACHCheck
This software requires the use of an encrypted card swiper. This will be shipped to the location indicated below and the licensee will be invoiced a one time charge of $200 per unit for this hardware.
YesNo
Please indicate total number of swipers needed (as stated this will be billed at $200 per unit)
SHIPPING ADDRESS
Billing Address Line 1*
Billing Address Line 2
City
State
Zip Code*
Phone Number
Please enter a valid phone number.
SOFTWARE SUBSCRIPTION AGREEMENT
FORM COMPLETED BY

Licensee agrees to license the following World Fuel proprietary software in accordance with the terms and conditions of the Agreement:
Legal Business Name*
I agree to these terms and conditions*
Completed By (Name)*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Title*
Desired Enrollment Date

MonthDayYear
Date
Please upload W-9 Form*

Cancelof
If you require assistance please email support_onboarding@wfscorp.com
Should be Empty:

P66 Enrollment Form

GENERAL INFORMATION

PHYSICAL ADDRESS

BILLING ADDRESS

SOFTWARE ORDER FORM

SHIPPING ADDRESS

SOFTWARE SUBSCRIPTION AGREEMENT

FORM COMPLETED BY