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Chevron Credit Card Application

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					                                   Business Card Application
Business Information               Facility #                                            Employee #                     ELEC

Full Legal Company Name:
DBA or AKA:
Business Street Address:
City:                                      State:                              Zip:

(If Different)
Mailing Address:          Same
City:                                    State:              Zip:
Phone #:                                 Fax #:                                    Email:

Accounts Payable
Contact Name:                                                    Phone #:

Type of Business:             Sole Ownership           Partnership         Corporation:         LLC/Partnership

Tax ID #:                                                  Nature of Business:

Years in Business:                                            Estimated Monthly Fuel $                                        /A Month

Federal Excise Tax Exempt?                   Yes      No

Type of Government:                 Non-Profit        Federal        State      County        City      School        Other

Owner/Officer Information

Name/Title:
Home Street Address:
City:                      State:                Zip:
Home Phone:                                     Social Security #:
If you currently have a Chevron or Texaco Card, please indicate the Account #:

Name/Title:
Home Street Address:
City:                          State:            Zip:
Home Phone:                                     Social Security #:
If you currently have a Chevron or Texaco Card, please indicate the Account #:

Customer Agreement
PLEASE READ CAREFULLY. By signing this agreement: (1) Applicant represents that the information given in this application is complete and accurate,
that applicant has no present intention to file for bankruptcy, and that applicant will notify Chevron Products Company (a Chevron U.S.A. Inc. division),
of any material adverse change in its financial condition; (2) Applicant authorizes Chevron Products Company to check with credit reporting agencies,
credit references and other sources to confirm information given and Applicant’s credit worthiness and to periodically request, receive and exchange
such information; (3) Applicant requests a Chevron and Texaco Commercial Account and cards issued as indicated; (4) Applicant agrees to the terms
and conditions set forth in the Commercial Account Agreement sent with the Chevron and Texaco Business Card and understands such terms and
conditions shall govern the Chevron and Texaco Commercial Account; (5) Applicant agrees that this account is non-transferable; and (6) the
undersigned represents that he/she is a president, vice president, chairman, general partner, member (L.L.C.), owner or sole proprietor and/or is duly
authorized to execute and deliver this application on behalf of Applicant. (7) Additional fees for fleet Management and other requested services may
apply.




Signature                                                            Date                                Name and Title (Print)
Please send completed form to: Redwood Oil Company Attn: Business Card Application, 50 Professional Center Dr. Ste 100, Rohnert
                                          Park, CA 92928 or fax to (707) 584-7078
PROG ID: 5010                                           Page 1 of 2
Fleet Management

# of cards requested:

How would you like your cards embossed (check only one option)
  Business Name Only
  Business Name & Driver(s) Name (complete Section A only)
  Business Name and Vehicle Description (complete Section B only)

Do you want odometer tracking?                  Yes   No

If you would like a card kept at a local station, please see your local retailer for more information.

Note: If you have more than 3 drivers or vehicles, please provide the additional information, where applicable, on a
separate sheet and include with this application. Please keep a copy for your records.

Section A: DRIVER INFORMATION

1. Please write the Drivers’ name(s) in the space below. Note: 17 character spaces available for Drivers’ Names.

2. Please indicate purchase restrictions:        NR = No Restrictions
                                                 FO = Fuel Only
                                                 AV = All vehicle-related products and services*

3. If you would like Driver ID Protection for any drivers, please choose a 6-digit ID #. If your company assigned ID#
   is less than 6 digits, use zeros. For example, ID# 4567 would become 004567.

4. If you would like Driver ID Protection for drivers and you would like to assign the ID#, please check here.

*Does not include car wash.
Driver’s Name                              Fuel Restrictions                          ID#
Example below

     John Smith                            FO                                         004567
1.
2.
3.

Section B: VEHICLE DESCRIPTIONS

(17 character spaces available for Drivers’ Names)

Make                                       Model                                      Year
1.
2.
3.




Please send completed form to: Redwood Oil Company Attn: Business Card Application, 50 Professional Center Dr. Ste 100, Rohnert
                                          Park, CA 92928 or fax to (707) 584-7078
PROG ID: 5010                                           Page 2 of 2

				
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Description: Chevron Credit Card Application document sample