Fuel1 Credit Application

Company Information
Company's Legal Name
Doing business as (DBA), If different from Legal Name
Billing Address

Street Address

Street Address Line 2

CityState

Zip Code
Physical Address

Street Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Business Start Date

MonthDayYear
Date
Tax Id #
# of Employees
Annual Sales
Type of Entity

Other
Principals/Ownership

Includes Officers, Partners, Directors, or Proprietor
Ownership 1
Public Filings
Has the Applicant, or any principals involved in the company, ever filed for protection under bankruptcy laws?
Bank References

(include deposit accounts and loans/lines of credit, if applicable)
Dealer/Seller Information
Equipment Information
vendor
Year
Make
Model
Requested Credit Limit
Personal Guaranty & Authorization
Name

First NameLast Name
DOB

MonthDayYear
Date
Social Security #
Signature
Name

First NameLast Name
DOB

MonthDayYear
Date
Social Security #
Signature
Should be Empty:

Personal Guaranty & Authorization