EDGE FUEL CARD APPLICATION

EDGE FUEL CARD APPLICATION
1. COMPANY INFORMATION
Legal Name of Business*
Trade Name
Phone Number*
Please enter a valid phone number.
Fax
Email*

Confirmation EmailConfirm Email
Physical Business Address*

Street

Street Address Line 2

CityState

Zip Code
Billing Address same as Physical Address*

YesNo
Billing Address (If different)*

Street

Street Address Line 2

CityState

Zip Code
Contact Person*

First NameLast Name
Cell Phone*
Please enter a valid phone number.
Email*
example@example.com
Federal ID or BIN #*
DOT #
Dun & Bradstreet #
Type of Business Organization (Check One)*

Sole ProprietorshipCorporationPartnershipLLC
Established in State*
Year*
Annual Sales
Has this firm or any of its principals ever filed bankruptcy?*

YesNo

2. PROPRIETOR, PARTNERS, OR CORPORATE OFFICERS
Name*

First NameMiddle NameLast Name
Title*
Social Security #*
Driver License
Cell Phone*
Email Address*
Residential Address: *

Street Address

Street Address Line 2

CityState

Zip Code
Is this the contact person for billing?*

YesNo
If No, Please Provide Billing Contact:
Billing Contact: *

First NameLast Name
Title*
Phone Number*
Please enter a valid phone number.
Cell Phone*
Please enter a valid phone number.
Fax
Email*
example@example.com

3. BANK & CREDIT REFERENCES
EFT INFORMATION

Auto draft is the preferred method of payment to establish a Fleet Account. Please include your EFT information below.

Electronic Funds Transfer Information:

Complete the below banking information to always stay up to date on invoice payments by using electronic auto-draft
Bank Account #*
Confirm Bank Account #*
The Bank Account does not match.
Bank Name*
Bank Routing #*
Bank Address: *

Street Address

Street Address Line 2

CityState

Zip Code
Contact Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Fax:
Email*
example@example.com
Customer hereby agrees and acknowledges that (1) North Star Management Group LLC may withdraw funds from the above-referenced bank account via electronic funds transfer at any time to collect on amounts due and owing North Star Management Group LLC; (2) a $50 processing fee will be debited to Customer’s account receivable for each transfer returned to North Star Management Group LLC for non-sufficient funds or for any other reason which would cause the funds to be unavailable for drawing by North Star Management Group LLC; and (3) North Star Management Group LLC will be reimbursed, on demand, by bank wire for the gross amount of each invoice not paid by the electronic transfer of funds in addition to the processing fee described above. This authority is to remain in full force and effect until North Star Management Group LLC and the above-referenced Depository have received written notification from Customer of its termination in such time and in such manner as to afford North Star Management Group LLC and the above-referenced Depository a reasonable opportunity to act on it.
Name*

First NameLast Name
Title*
CREDIT REFERENCES

Please provide the information below for companies that provide you with credit terms.

Credit Reference # 1
Company Name
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Credit Reference # 2
Company Name
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Credit Reference # 3
Company Name
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Credit Limit Requested – Per Month $

4. CREDIT TERMS & CONDITIONS AGREEMENT
In consideration of the opening of a Fuel Management Systems account of North Star Management Group LLC (SUPPLIER) and blanks*(USER), the undersigned agrees to the following in all credit transactions with North Star Management Group LLC, unless otherwise Agreed to in writing by an authorized company officer:
1. USER agrees to follow all posted instructions for the fueling of vehicles and will comply with all posted safety procedures. USER acknowledges receipt of systems operation cards and agrees to instruct all USERs of the system’s correct use.

2. USER agrees to pay the Fuel Management System Fees set forth in this agreement in accordance with the following terms:

a) Payment will be due on demand; invoices will be billed weekly or every 10 days. Payment by invoice will be made according to the terms and due dates shown on each invoice. All payments are due within the period stated herein.

b) A service charge of ($50.00) will be charged against all returned payments.

c) USER agrees to pay all attorney’s fees or collection charges associated with the collection of its past due account. Any legal proceedings with respect to this account will be handled at the Los Angeles California Municipal Court.

3. USER hereby accepts the obligation and responsibility for payments for all fuel registered through the Fuel Management Account number(s) assigned as USER by SUPPLIER. USER will notify SUPPLIER of any lost card immediately upon termination that a Fuel Management Card has been lost or stolen. Notice may be given orally, but MUST be confirmed in writing within 24 hours, by registered or certified mail. USER agrees to pay for all product delivered through the Fuel Management System prior to such written notice.

4. If a fuel Management System Card is locked out, written application must be made to reinstate a Fuel Management System Card or account, SUPPLIER reserves the right to refuse to reinstate past due accounts. No cancelled account may be reinstated unless all monies owed are paid, including all finance charges and fees. A $50.00 dollar charge will be made to reinstate any account.

5. USER understands that card restrictions (profiles) are not guaranteed.

6. This agreement may be cancelled upon 24-hour written notice by SUPPLIER or USER. Should USER cancel account all monies due will be paid within 10 days of such cancellation.

7. USER understands and agrees that his/her right to the Fuel Management Systems account may not be assigned.

8. USER accepts any and all liability arising from the misuse, unauthorized use, loss or theft of any Fuel Management Systems Card resulting in access to the Fueling Systems maintained and operated by North Star Management Group LLC. USER understands that the rights conferred herein allow USER to access and use products on private premises not open to the general public and in consideration for the duties of USER under this agreement. USER agrees not to write the personal identification number (PIN) code on any Fuel Management Systems Card and keep (PIN) separate from card at all times.

9. USER agrees that any environmental charge levied against North Star Management Group LLC for negligent use by customer of its card or equipment shall promptly pay these charges.

10. USER will promptly notify North Star Management Group LLC of any change in residence, business or mailing address.

11. At all retail Locations, where the same pumps are being used for both retail and card lock sales, the posted per gallon price does not necessarily reflect the actual per gallon price. Prices posted on pump reflect cash, or credit card pricing only. Not card lock prices.

12. SUPPLIER reserves the right to charge USER'S credit accounts on past due invoice amounts.

13. Terms of this agreement may be amended by SUPPLIER at its sole option at least one full invoicing period notice.
I have read, understand and agree to the Terms and Conditions of the Fuel Management Systems account presented above. I authorize the references listed in Part 3 and 4 to release to North Star Management Group LLC information related to applicant’s accounts.
I hereby declare the forgoing information is true and correct; I/We authorize North Star Management Group LLC to conduct a credit check on both personal and business as applicable. I understand that the information therein will be used in the decision of whether or not to grant a credit account with SUPPLIER. I agree to abide by North Star Management Group LLC credit policy if credit is granted.
Guarantor Name*

First NameLast Name
Guarantor Title*
Guarantor Signature*

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Company Name*
Date*

MonthDayYear
Date

5. CONTINUING GUARANTY
For valuable consideration, including the inducement to provide credit to blanks*(Company Name-hereinafter called “Debtor”) which would otherwise be denied, the undersigned (hereinafter called “Guarantor”) absolutely and unconditionally guarantees and promises to pay North Star Management Group LLC (hereinafter called “Company”) its affiliates, successors and assignees, or order, in lawful money of United States any and all indebtedness of debtor to Company in whatever amount may be owing to Company whether such indebtedness now exists, or is incurred hereafter, whether voluntary and however arising whether absolute or contingent, liquidated or unliquidated, determined or undetermined, and whether Debtor may be liable individually or jointly with others, or whether recovery on such indebtedness maybe or hereafter become barred by any statute of limitations.

This is a continuing guaranty relating to any and all indebtedness, including that arising under successive transactions which shall either continue this indebtedness or renew it after it has been satisfied. This guaranty shall not apply to any indebtedness created after receipt by Company of written notice of its revocation as to future transactions, such notice to be sent by Certified Mail, Return Receipt Requested, to Company at: 14264 Valley Blvd, Fontana, CA 92335. The termination of the guaranty shall not have any retroactive effect with respect to obligations of Debtor incurred prior to termination. Guarantor agrees that it is directly and primarily liable to Company, that the obligations hereunder are independent of the obligation of Debtor, and that a separate action or actions may be brought against Guarantor when action is brought against Debtor or whether Debtor is joined in any such action or actions. Guarantor agrees to pay a reasonable attorney fee and all other costs and expenses which may be incurred by Company in the enforcement of this guaranty. This guaranty shall not be abrogated or affected in any manner by any change in the firm or status of the Debtor, whether caused by death, by the admission of any new member or members or by the withdrawal of any member, or by any change from any cause whatsoever.
Guarantor Signature*

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Name*

First NameLast Name
Title*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
A COPY OF THIS GUARANTY SHALL BE AS VALID AS THE ORIGINAL
Should be Empty:

EDGE FUEL CARD APPLICATION

1. COMPANY INFORMATION

2. PROPRIETOR, PARTNERS, OR CORPORATE OFFICERS

3. BANK & CREDIT REFERENCES

4. CREDIT TERMS & CONDITIONS AGREEMENT

5. CONTINUING GUARANTY