Raceway Fleet Card Application

 APPLICANT- Please read the following before completing this form: (1) A representative of the company authorized to enter into contractual agreements must sign this application. (2) The Personal Guaranty section must be completed and signed by an authorized officer of the company. (3) PLEASE READ AND SIGN BELOW BEFORE SUBMITTING THIS APPLICATION. 

Business Name:

How long in business?

Nature of Business?

Type of Business?

Federal Tax ID:

Business Address:

Street:

City:

State:

Zip:

Billing Address:

Street:

City:

State:

Zip:

Phone #:

Dun and Bradstreet Duns #:

Fleet Account Contact:

Contact Name:

Title:

Phone #:

Fax #:

Email Address:

Total Number of Cards Requesting:

Estimated Monthly Usage $:

Bank Reference:

Bank Name:

Address:

City:

State:

Zip:

Contact Name:

Phone #:

Account #:

Trade References:

Company:

Contact Name:

Phone #:

Company:

Contact Name:

Phone #:

Company:

Contact Name:

Phone #:

Personal Guaranty Information:

Last Name:

Initial:

First Name:

Home Address:

Street:

City:

State:

Zip:

Home Phone #:

Birth Date:

Social Security #:

Email Address (Optional):

By providing my e-mail address, I consent to receive e-mail communications about my account. 

PERSONAL GUARANTY 

In consideration of the seller financing purchases under the Raceway Commercial Charge Account Agreement, the undersigned hereby agrees to unconditionally, absolutely and irrevocably personally guarantee payment of all amounts due under, and performance under the terms of, the Agreement, and further agrees to pay the total balance due on the account opened pursuant to the agreement upon demand, without requiring Raceway Petroleum, Inc., or any assignee hereof, to proceed first to enforce payment against the buyer also liable on this account, in the event any default under the Agreement that governs the account. The buyer agrees to be responsible for any legal fees associated with collecting any amounts due on the account. The undersigned hereby waives any notices regarding the Agreement or this guaranty, and agrees that this guaranty shall be applicable until after the Agreement has terminated and all amounts due there under shall have been paid in full. The undersigned guarantor agrees that in the event the account has not been paid as agreed, Raceway Petroleum, Inc. may report the undersigned's liability for and the status of the account to credit bureaus and others who may lawfully receive such information. Personal credit history of the undersigned guarantor will be used in making a credit decision and the undersigned guarantor authorizes Raceway Petroleum, Inc. to obtain a consumer report from a credit bureau. Direct inquiries of employers and businesses where the undersigned guarantor maintains accounts may also be made. Undersigned Guarantor must be an authorized officer of the company. 

PERSONAL GUARANTOR

X

DATE

NOTICE TO BUYER: (1) By signing below on behalf of your business, you represent that your business is a valid business entity; and that you are an authorized representative of the business with the authority to enter into contractual agreements. On behalf of the business, you certify that all information provided in the Application is complete and accurate. You agree to be bound by the terms of the governing credit agreement of the type elected in this Application and subsequently for purposes of updates, renewals or extensions of credit granted as a result of this Application or in receiving or collecting the Account. You also understand that credit on this Account, once approved, will be extended by Raceway Petroleum, Inc., and that there is no binding contract between us until Raceway Petroleum, Inc. approves and accepts this Agreement. 

SIGNATURE

X

DATE

GENERAL TERMS AND CONDITIONS 

All accounts will be billed on a semi-monthly basis. Billing periods will be from the 1st to the 15th and the 16th to the last day of the month. Bills will be sent on the first business day following the end of the billing cycle. Payments are to be received within 15 days from date of Invoice. A Monthly Late Payment Charge of 1.5% will be assessed if payment in full is not received within 30 days of Invoice date. Monthly Accounting Fee of one half of one percent of total purchases will be assessed. 

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