Cropper Oil Fuel Card

Get Fuel 24 Hours a Day!

Full Service: Monday through Friday, 7am to 5pm
Invoiced twice per month
5 cents/gallon discount for payment within 10 days of invoice
Odometer tracking helps you track your vehicle's mileage per gallon
For individual use or Business Fleets
Invoice tracks usage for each vehicle in a fleet

Please fill out this application for consideration of a card of your own...

Personal Information:
Name:		Home Address:
City, State		Zip:
Home Phone:		Spouse's Name
Date of Birth:		Own or Rent?
Social Security Number:
Employer Name:		Employer Address
Employer City, State		Employer Zip
Position:		Years There
Landlord's Name		Landlord's Phone

Business Information
Business Name		Business Address
Business City, State		Business Zip
Nature of Business		Business Phone
Owner Information (Please include owners, partners and officers.)
Owner Name		Home Address
City, State		Zip
Social Security Number		Home Phone
- - - - - - - - - - - -
Owner Name		Home Address
City, State		Zip
Social Security Number		Home Phone
- - - - - - - - - - - -
Owner Name		Home Address
City, State		Zip
Social Security Number		Home Phone
Credit/Trade References and Bank Accounts:
Type of Account		Name on Account
Name of Banking Facility/Creditor		Facility Address
Facility City, State		Facility Zip
Account Number
- - - - - - - - - - - -
Type of Account		Name on Account
Name of Banking Facility/Creditor		Facility Address
Facility City, State		Facility Zip
Account Number
- - - - - - - - - - - -
Type of Account		Name on Account
Name of Banking Facility/Creditor		Facility Address
Facility City, State		Facility Zip
Account Number
- - - - - - - - - - - -
Comments:

Application is hereby made for a Cropper Oil Fuel Card(s) and I agree to be responsible for control of such card(s) and to pay for all products obtained with such card(s) in accordance with credit terms as established by my separate credit account with Cropper Oil Co., Inc. I understand that you will issue cards at no cost as I request them until I cancel. Replacement cards will be issued upon surrender of old card; otherwise, there will be a charge of $25.00 for non-returned cards. Card(s) not used for a period of 90 consecutive days will be deemed a non-returned card and cancelled. I further acknowledge and agree to abide by the regulations issued by Cropper Oil Co., Inc., its employees, dealers and their attendants, and Federal, State, and Local regulatory agencies. If this is a personal account, I agree, or if this is a Fleet account, both I and the company agree, to be liable for all charges to all cards that are requested by me.