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Multi Service Fuel Card Account Application

Business Information

The information requested will be used to determine a line of credit for your account.
Please complete to the best of your ability.

Bold: Required

Legal Name of Business

Street Address

Country

State

City

Zip

E-mail Address

E-mail Confirmation

Phone Number

Fax Number

Mobile Number

MC #

Federal ID #

For Canadian Applicants
Canadian Business #
Provincial Operating License

Owner Information

If you manage a new or small fleet, there may not be enough credit history on
your company to establish your account. In this case, we may ask you to submit
additional information for underwriting review to process your credit line request.

Bold: Required

First Name

Last Name

Title

Same as Business Information

Street Address

Country

State

City

Zip

Phone Number

E-mail Address

Authorized users can access and authorize changes to your account.

Add Authorized Users

First Name
Last Name
Phone Number
E-mail Address
E-mail Confirmation

Customer Options

Bold: Required

Credit Line Requested

# Trucks

# Cards

Are you working with a Sales Person?

Terms and Conditions

Agree

View Terms and Conditions

Multi Service Corporation the assigned "Company" and "Cardholder", are legally bound as follows: Company is engaged in the business of providing a purchase program for fuel and other products and services as set forth in the purchase policy; and Cardholder requests Company to provide a purchase program. Company is not a seller of merchandise. Company's sole function is to furnish credit and billing services, Company does not warrant any merchandise or services from whatever source obtained by the use of Company's credit or billing services. CARDHOLDER PURCHASE POLICY Cardholder has chosen the purchase policies indicated on the signed Account Application. The truck stop must obtain a purchase order number fromCardholder before any exception to purchase policies is paid by Company. Variations from stated policies, unaccompanied by the purchase order number, will not be paid to truck stop by Company or billed to Cardholder by Company, unless Cardholder approves all variations. For any cash advances of $200 or more a maximum fee of up to 3% will be assessed. Company reserves the right to change the terms of this Application by giving Cardholder 15 days advance notice of the change. Late payments will be assessed a late charge of 1 1/2 % per month. In addition, a Credit Line fee up to 5% may be assessed. The Cardholder represents that the purchases under the purchase program are for business or commercial credit only. Use of the card(s) by Cardholder includes use by the Cardholder or anyone under its control and Cardholder's signature in connection with any card transaction signifies Cardholder's agreement to the terms and conditions set forth herein. The Cardholder is liable for any unauthorized use of the card(s). In addition, Company is entitled to offset any amount it may oweCardholder or its owners, or any affiliate of Cardholder or its owners, against any claims it has against Cardholder. Notice of a disputed transaction shall be provided by Cardholder to Company in writing and shall include customer number, card number, disputed amount, invoice number and date of transaction. If not disputed within 30 days of the transaction date, all charges are considered valid and no adjustments will be made. CARD CANCELLATION POLICY Cardholder shall notify Company promptly of any lost or stolen card(s) or to cancel card(s). Cardholder is responsible for all purchases on lost, stolen or cancelled card(s) prior to written notification of cancellation to Company. CARDHOLDER CREDIT Cardholder shall furnish Company or Company's agent with current financial information. If Cardholder does not wish to provide current financial information,Cardholder may furnish the Company a bank letter of credit or other sufficient security prior to the Company's issuance of any card(s) to Cardholder. Cardholder shall weekly, or more frequently as may be necessary to keep the account balance within the line of credit or within payment terms, make payments to the Company or the Company's designated agent. Cardholder agrees to the method of payment as specified in the Customer Options section of the Account Application. If Cardholder's bank or Cardholder for any reason should fail to timely pay any amount due Company, Cardholder understands and agrees that Company may immediately suspend all cards held by Cardholder and draw against letter of credit or other security held by the Company on behalf of the Cardholder. There will be a card issuance fee of $50 plus $5 per card if cards are not used within 60 days from the delivery date. Any payments received will be applied first to the past due balance, then to any new purchases. MSC can raise or lower the credit line at its sole discretion without notification to Cardholder. TERMINATION This Agreement may be terminated by either party by giving written notice to the other party. Upon termination, Cardholder shall immediately return to Company all cards in the possession or under the control of the Cardholder, and will pay the sums due Company according to the above payment procedure. Upon termination of this Agreement, Cardholder shall have the responsibility to pay all amounts incurred or costs associated with Cardholder's account whenever incurred. GOVERNING LAW This Agreement and the Continuing Guaranty are governed by the laws of the State of Missouri, and it is agreed the jurisdiction of any legal action connected with this Agreement shall be exclusively in the state or federal courts located in the State of Missouri. Notwithstanding, Company may, at its option, choose to pursue legal action against the Cardholder in any state in which the Cardholder does business or where jurisdiction may otherwise be proper. To secure all of Cardholder's obligations and liabilities to Company under this Agreement, and all obligations and liabilities of Cardholder to Company under any other document or agreement between Cardholder and Company executed from time to time, the Cardholder hereby grants to Company a continuing lien and security interest in all of Cardholder's accounts, accounts receivable, equipment, inventory, instruments, deposit accounts, chattel paper and all general intangibles. Cardholder agrees that it will not sell or assign any of its accounts or accounts receivable, or any chattel paper or instrument, without the prior written consent of Company which such consent may be conditioned upon, in Company's sole discretion, any such buyer agreeing to pay directly to Company the amounts to be paid in connection with any such sale or assignment. GUARANTY Given by the undersigned (the "Guarantor") to Multi Service Corporation (the Company), in order to induce the Company to extend credit to, or otherwise become the creditor of the Cardholder (for purposes of this section hereinafter referred to as the "Debtor"). In consideration of the foregoing, Guarantor hereby guarantees to the Company, its successors, and assigns, prompt payment, when due, of every claim of the Company which may hereafter arise in favor of the Company against the Debtor. Such claims shall include every note, check, loan, open account, bills payable, and any other type of claim or indebtedness, in connection with which, whether directly or contingently, the Debtor is or shall become liable to the Company. In the event of default of the Debtor to make payment on any claims of the Company when due, Guarantor agrees, without the Company first having to proceed against the Debtor, to pay on demand all claims due and to become due to the Company from Debtor, and all losses, costs, attorney's fees, or expenses which Company may suffer by reason of Debtor's default. This is a continuing guaranty and shall remain in force until revoked by the Guarantor by notice in writing to the Company, provided that such revocation shall be effective only as to claims of the Company which arise out of transactions entered into more than 30 days after the Company's receipt of such notice. Guarantor hereby acknowledges and agrees that neither the legal disability of Debtor to incur such indebtedness or obligation nor the non-existence of Debtor, whether now or at a later date, will relieve it of its obligations under this guaranty. Please provide two signed forms of identification for each guarantor. DEFAULT PROVISIONS In the event Cardholder defaults in payment of its obligation to MSC, Cardholder irrevocably authorizes MSC, at MSC's option, to notify any person or entity providing financing to Cardholder or purchasing any account from MSC (each a "Lender/Factor") of such default and Cardholder hereby irrevocably directs and authorizes any such Lender/Factor to wire directly to MSC any funds available to such Lender/Factor as such Lender/Factor funds Cardholder or any funds received by such Lender/Factor as a payment on any accounts purchased by such Lender/Factor from Cardholder, until the balance from Cardholder to MSC is paid in full. Cardholder is and shall be liable to the Company for all costs and expenses incurred by the Company in collection and enforcing its rights hereunder, including, but not limited to, late charges and attorney's fees, if any, incurred by the Company to collect all amounts due on Cardholder's account and/or foreclosing on its lien and security interest. The Cardholder agrees that in the event of default, Company may institute suit against the Cardholder in the aforesaid courts and that service of process by certified mail, return receipt requested, postage prepaid and addressed to the Cardholder shall be sufficient to confer jurisdiction of said courts, regardless of where Cardholder is geographically located or does business. I hereby authorize Multi Service Corporation to obtain credit reports in connection with my application and to obtain credit information from my bank. All financial information submitted in support of this account application is true and complete in all respects. By signing this account application I certify that I am authorized to make the request on behalf of this company.