Account Set-up Information Business Name: Accounts Payable Contact: Telephone: Fax: Representative E-Mail Address: E-Mail Address for product updates and compliance information: Purchase Order Needed: Yes (answer below) No Standing PO: Customer To Provide PO At What Time: At time of Order At time of Delivery At time of Invoice Special Instructions: Indicate Invoice Delivery Method (E-Mail is our preffered method) E-Mail E-Mail address: Mail ATTN Line: Fax Fax # and ATTN: Ship to Location Name (if different): Ship To Address: City: Country: State: Zip: Is the ship to address inside or outside city limits? Inside City Limits Outside City Limits Ship To Contact: Telephone: Fax: Driving Directions: Receiving Hours: Special Unloading Requirements: CIRCLE products that will be ordered and LIST applicable tank sizes for each as these will be the products listed on your account. Tank Size Monthly Volume Unleaded Midgrade Super Other Oil/Lubes - Bulk Tank Size Monthly Volume Low Sulfur Diesel Ultra Low Sulfur Diesel Dyed High Sulfur Diesel Dyed Low Sulfur Diesel Oil/Lubes - Packaged Sales Tax Oils & Lubricants N/A Yes No If no, a resale or exemption certificate must be attached Sales Tax Parts & Equipment N/A Yes No If no, a resale or exemption certificate must be attached Sales Tax Services N/A Yes No If no, a resale or exemption certificate must be attached Sales Tax Fuel (N/A in Texas) N/A Yes No If no, a resale or exemption certificate must be attached Sales Tax Yes No If no, applicable permit must be attached Federal Tax Yes No If no, applicable permit must be attached (N/A on dyed diesel) Above Ground Tanks Yes No Destination for Product Tank Train Boat Generator Other Please check the following: Bobtail Transport ** Monitor Customer Reseller End User ** Price Doc Customer Market Segment:(Cricle One) Crude Fleet Fueling Frac Generator Lubes Mainstream Railroad Account Classification:(Cricle One) Transportation Rail Drilling Generator Agriculture Marine Construction Retail Industrial Aviation Goverment Service
