Credit Application for Business Account Form

Arizona Fuel Distributors

BUSINESS ACCOUNT CREDIT APPLICATION AND AGREEMENT
BUSINESS INFORMATION
Company Name*
Trade Name or DBA (if applicable)
Phone Number*
E-mail*
example@example.com
Company Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Company Physical Address (if different than above)

Street Address

Street Address Line 2

CityState

Zip Code
Company Type*

Sole ProprietorshipPartnershipCorporationGovernmental AgencyLimited Liability CompanyLimited PartnershipOther
Record all Applicable License Numbers (or N/A)*
Formation, State of*
Date of Formation/Incorporation*
Type of Business*

PRINCIPAL(S)
Name*

PrefixFirst NameMiddle NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
How Long at This Address?*
Social Security Number*
Relationship to Applicant:*

Corporate OfficerPartnerMemberOwnerOther
Have you or any company in which you were an owner, officer, director, shareholder, member, or manager ever filed for Bankruptcy, or had anyjudgments, or tax liens filed against you?*

YesNo

Business Office Information
Accounts Payable Contact*

First NameLast Name
Accounts Payable Phone*
Accounts Payable Fax
Accounts Payable E-mail*
example@example.com
Company Billing Address (if different than above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email to receive the notifications below*
Email to receive the notifications below
Select all that apply to the email above

PRICINGEFTINVOICESTATEMENTS
Select all that apply to the email above

PRICINGEFTINVOICESTATEMENTS

Trade References
Reference 1: Company Name*
Phone Number*
Reference 2: Company Name*
Phone Number*

Agreement

(By checking these boxes you are agreeing to our terms - should you have any questions please contact us)
- Arizona Fuel Distributors L.L.C., will hereinafter be referred to as “Arizona Fuel.”
- As Principal of ("Principal" in Principal Section above), I promise and guarantee that all information provided on this application and agreement is true and complete and that if accepted by Arizona Fuel, Customer agrees to be bound by all the terms and conditions stated herein. Customer represents to Arizona Fuel that it is a commercial account and that the fuel to be purchased will be used for resale, business, commercial, or agricultural purposes. Customer authorizes Arizona Fuel to investigate Customer's credit history, either in connection with this application for credit or later in connection with any update, renewal, or extension of additional credit under this Agreement. Customer further authorizes Arizona Fuel to furnish information concerning Customer's accounts to consumer reporting agencies and others who in Arizona Fuel's discretion may properly receive such information.
- Initial and any continuing Credit is to be extended at sole discretion of Arizona Fuel and upon such terms and conditions as Arizona Fuel may, in its sole discretion from time to time determine. Credit limitations set on this account shall be for the protection of Arizona Fuel and shall not be construed to be a limitation on the liability of the company's account or any personal guarantee. Arizona Fuel retains sole discretion to terminate services with or without notice, when Customer's credit limit is reached, or for any other reason. Arizona Fuel's failure to enforce any specific right or otherwise indulge the company shall not be deemed a waiver of this agreement or any part of this agreement.
- In the event Arizona Fuel is willing to extend credit to Customer, it will notify Customer. No credit is agreed upon until such notice is given.
- Customer agrees to pay all charges when due. Any late payment shall accrue interest at the rate of 18% per annum unless limited by law to a lower rate, on the entire unpaid balance. Arizona Fuel may at any time and without notice refuse to permit further credit purchases.
- Delivery of products made to the Customer's tanks, vehicles or equipment may be made without obtaining signatures or receipts upon delivery.
- The Customer is obligated for purchases made in the name of the company notwithstanding any change in the form of business or sale of the business to a third party unless written notice, as described below, is given first.
- Customer shall indemnify and hold Arizona Fuel harmless from any claims, costs, damages, and attorneys fees, including but not limited to those for bodily injury and damage, which may be occasioned by or attributed to the Customer or its agents, employees, or independent contractors while on Arizona Fuel's premises.
- Arizona Fuel shall not be liable for any loss or damages, including consequential damages, which may result from failure to provide fuel or the failure of equipment to operate in any manner whatsoever.
- Arizona Fuel may without notice cancel the Customer's right to use and/or may reduce company's credit limit at any time. Upon notice, Arizona Fuel may amend this agreement at any time and all subsequent purchases shall be subject to such amendment. No cancellation will effect Customer's obligation to pay charges incurred.
- Any provision(s) under this agreement which may prove invalid or unenforceable under any law, rule, or regulation of any governmental agency, will not affect the validity or enforceability of any other provision of this agreement.
- Customer understands that no officer, employee, agent or assignee of Arizona Fuel has authority to waive any provision of this agreement, nor shall an industry custom or practice vary the expressed provisions contained herein. It is not necessary for Arizona Fuel to inquire into the powers of Customer or its officers, agents or partners to incur indebtedness. Indebtedness of Customer to Arizona Fuel created in reliance upon the professed exercise of such powers is hereby guaranteed.
- Any change or cancellation of this Agreement by Customer or cancellation of any Personal Guarantee shall not be effective until delivered at Arizona Fuel's mailing address of: P.O. Box 63634, Phoenix, Arizona 85082-3634.
- Arizona Fuel may send invoices or statements and any notices to Customer at the address shown on this application. Notice shall be deemed delivered upon mailing.
- Customer agrees to timely and immediately supplement in writing all information provided herein as the changes occur. Customer agrees to immediately notify Arizona Fuel in writing of any change in ownership or of the officers, partners, managers or authorized representatives of Customer.
- If Customer's account is referred for collection, the Customer shall pay, in addition to all principal and interest, all attorney's fees and costs of collection, including collection agency fees. Customer agrees that jurisdiction and venue for any dispute under this agreement shall be County of Maricopa, State of Arizona. This application, agreement and personal guarantee shall be construed in accordance with the laws of the State of Arizona.
- Arizona Fuel may offset any amounts due by Arizona Fuel to Customer against any amounts due by Customer to Arizona Fuel. In the event Customer fails to make payment of any amount when due, then all amounts due from Customer to Arizona Fuel shall be accelerated and immediately become due and payable. Any debt or other obligation owed by Customer to its Principal(s) is hereby subordinated to the obligation of Customer to Arizona Fuel.
- The undersigned is fully authorized to bind company to this agreement and company agrees to be bound by all the terms and conditions stated herein.

CONTINUING PERSONAL GUARANTEE
The undersigned (Guarantor) hereby acknowledges and agrees that credit will not be extended to Customer without the execution of this personal guarantee. Guarantor acknowledges and agrees that Arizona Fuel is relying on the accuracy of all representations made herein in extending credit to Customer. Guarantor agrees to pay all amounts which become due pursuant to this Agreement. Guarantor authorizes Arizona Fuel to investigate Guarantor’s credit history, either in connection with this application for credit or later in connection with any update, renewal, extension of additional credit, or collection activities under this Agreement. Guarantor acknowledges that any limitation on the Customer's credit shall not be construed to be a limit on the liability of Guarantor. Guarantor further acknowledges and agrees to pay all expenses of collection including reasonable attorneys' fees, costs, and collection agency fees incurred by reason of the default of the Customer or the default of Guarantor. Guarantor waives prior demand or presentment on Customer. This is a continuing guarantee and shall be revocable only as to transactions entered into thirty (30) days after Arizona Fuel's credit department receives a "Notice of Termination of Guarantee" sent by Guarantor to Arizona Fuel c/o Credit Department P.O. Box 63634, Phoenix, Arizona 85082-3634.by certified mail. The Guarantor's signature below with no spousal signature constitutes a warranty and a representation that the Guarantor is not legally married or in a legal Civil Union and an acknowledgement that Arizona Fuel is relying upon that representation in issuing credit to the Customer.
Agreement and Terms*

By checking, you agree to all terms and conditions of the Agreement and Continuing Personal Guarantee
Guarantor Signature *

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AUTHORIZATION AGREEMENT FOR ELECTRONIC FUND TRANSFER (EFT)
The undersigned company ("COMPANY") authorizes Arizona Fuel Distributors L.L.C. ("ARIZONA FUEL") to originate debit entries to its checking account as indicated below and the Depository Institution ("BANK") to accept and to debit the amount of such entries from the COMPANY'S account. Such entries will be limited to the
invoice amount(s) on their respective due dates for products/services ordered by the COMPANY or its representatives from ARIZONA FUEL. Terms and conditions governing the EFT may be amended from time to time upon written agreement of ARIZONA FUEL and the COMPANY.
PLEASE UPLOAD AN IMAGE OF VOIDED CHECK*

Cancelof
This agreement is to remain in full force and effect until ARIZONA FUEL and BANK receive written notification of termination from COMPANY, and in no event termination be effective with respect to debit entries originated prior to ARIZONA FUEL 'S receipt of notice of termination. This agreement shall be governed by the NACHA Operating Rules in effect from time to time. The COMPANY understands that debit entries will be honored if sufficient funds are available in the COMPANY'S account. In the event a debit entry is returned to ARIZONA FUEL uncollected,the gross amount of the invoice or invoices covered by it will be immediately due and payable along with any associated finance and bank charges, and further participation in this Plan, at the option of ARIZONA FUEL, may be terminated. Future purchases, if the plan is terminated, will then be on terms as approved by ARIZONA FUEL. In the event any error in billing, invoicing or pricing occurs, ARIZONA FUEL will promptly make the correction. ARIZONA FUEL reserves the right to cancel this program at any time by written notice to the company.
Agreement and Terms*

By submitting this business information, credit application, and EFT Authorization, you authorize us to make inquires into the banking and buisness references that you provided.
Authorized Signature from COMPANY*

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DELIVERY LOCATION INFORMATION SHEET
COMPANY NAME
SITE FULL BUSINESS NAME
LOCATION ADDRESS *

Street Address

Street Address Line 2

CityState & County

Postal / Zip Code
LOCATION DELIVERYHOURS AND DAYS*
SITE CONTACT INFORMATION*
FUEL TANK INFO*

Above Ground TanksVaulted TanksPump Truck NeededUST Exempt (send certificate separately)
Tank 1 GAL/Product*
Tank 2 GAL/Product*
Tank 3 GAL/Product*
Tank 4 GAL/Product*
SPECIAL INSTRUCTIONS:
Should be Empty:

Arizona Fuel Distributors

BUSINESS INFORMATION

PRINCIPAL(S)

Business Office Information

Trade References

Agreement

CONTINUING PERSONAL GUARANTEE

AUTHORIZATION AGREEMENT FOR ELECTRONIC FUND TRANSFER (EFT)

DELIVERY LOCATION INFORMATION SHEET