Online Credit Application

Customer Profile

NAME OF COMPANY

YEARS IN BUISNESS

TRADE, STYLE NAME

REGISTERED

ADDRESS

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

PHONE

FAX

Branch Offices

BRANCH OFFICE(S) & ADDRESS

LINE OF BUSINESS

DO YOU OWN THE BUILDING?

SQ FT

NAME, ADDRESS, TEL/FAX # OF LANDLORD

DO YOU HAVE OTHER OWNERSHIPS, OR INTERESTS?

PREVIOUS AFFLIATIONS, IF ANY

AMOUNT OF CREDIT REQUIRED

ANNUAL SALES

EMPLOYEE #

OWNERSHIP: CORP

PUBLICLY LISTED

PROPRIETORSHIP

PARTNERSHIP

LLC

Company Fed & State Tax ID

Please provide state sales tax exemption certificate.

FEDERAL TAX ID#

STATE TAX ID#

D&B DUNS NUMBER

PRODUCT FOR RESALE Y/N

Accounts Payables

CONTACT NAME

EMAIL

PHONE

CELL

FAX

Officers / Owners Contact

OFFICERS/OWNERS CONTACT

NAMES OF OFFICERS/OWNERS

TITLE

TELEPHONE

Trade References

TRADE REFERENCES

COMPANY

ADDRESS

CONTACT

PHONE

Banking Information

ACCOUNT #

BANK NAME

ADDRESS

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

EMAIL

PHONE

Terms and conditions

IMPORTANT: APPLICATION VOID WITHOUT AUTHORIZED SIGNATURE(S)

AUTHORIZED SIGNATURE*

Please type name

Date*

ADVANCED FUEL SOLUTIONS, INC. (AFS) TERMS OF SALES ARE NET 30 DAYS. ESTABLISHED TERMS WILL BE ON A PREPAID BASIS. CREDIT CARDS NOT ACCEPTED

*FOR AFS CREDIT DEPARTMENT USE ONLY *

CREDIT REQESTED

CREDIT LIMIT

APPROVED BY

Date

REVIEW

Name

This field is for validation purposes and should be left unchanged.

Credit Application Form

Customer Profile

Branch Offices

Company Fed & State Tax ID

Accounts Payables

Officers / Owners Contact

Trade References

Banking Information

Terms and conditions

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