FLEET CREDIT APPLICATION
Let us help you improve your bottom line with our fleet card program.
Additionally, our Maverik website allows you to manage your fleet
accounts on a daily basis.
We can set you up with multiple cards on one account or single cards
on multiple accounts. Let’s talk and see what would be best for your
company.
Contact Maverik, Inc. with any questions that you may have.
Customer Service
(800) 789-4455
Maverik Fleet Credit Card Application
Return completed application to: Maverik , Inc. PO Box 9000 Afton, WY 83110 E-mail: [email protected] Fax: (307) 885-3832 APPLICANT
Complete Business Phone #
Mailing Address Years in Business
Business Address Years under Present Ownership
City State ZIP
Dun and Bradstreet Federal ID # __Corporation
__ LLC __Partnership __Proprietorship
CONTACTS
Primary Contact's Name Email address Phone #
Names and Residential Addresses of Owner/Partners
Name Street Address City State ZIP Phone #
Name Street Address City State ZIP Phone #
Name Street Address City State ZIP Phone #
CREDIT INFORMATION
Name of Bank Address Account Number
Name of Bank Officer Phone #
Trade Credit References
Name Street Address Account Number
City State ZIP Phone #
Name Street Address Account Number
City State ZIP Phone #
Name Street Address Account Number
City State ZIP Phone #
Requested credit limit per account Monthly Due Date
Choose the type of card(s) you want. You can have both types of cards depending on the needs of your fleet. Please note the following card types and functionality:
The Driver Cards, which are driver-based, will prompt you for a driver PIN, and vehicle number and odometer reading if requested below. The transaction will be authorized based on the PIN, and vehicle number, if applicable. If odometer readings are provided, mileage will be tracked for you on our fleet web site and monthly statements.
- To order Driver Cards with PIN prompt only, please complete the Driver Cards Detail below.
- To order Driver Cards with PIN, Vehicle, and Odometer prompts, please complete Driver Cards Detail
below and the Vehicle Description (for each vehicle) section only in the Vehicle Cards Detail below. The Vehicle Cards, which are vehicle-based, will prompt you for a driver PIN, and vehicle number and odometer reading if requested below. The transaction will be authorized based on the PIN, and vehicle number, if applicable. If odometer readings are provided, mileage will be tracked for you on our fleet web site and monthly statements.
- To order Vehicle Cards with PIN prompt only, please complete the Vehicle Cards Detail below and the
Driver First Name and Driver Last Name (for each driver) sections only in the Driver Card Detail below.
- To order Vehicle Cards with PIN, Vehicle, and Odometer prompts, please complete the Vehicle Cards
Detail below and the Driver First Name and Driver Last Name (for each driver) sections only in the Driver Card Detail below.
Additionally, for each card, you can choose to have the capability to: (1) purchase fuel only; (2) fuel with oil only; (3) fuel with all store products.
Number of Cards Requested
Numbe r of Drive r Cards Numbe r of Ve hicle Cards Total Cards
DRIVER CARDS DETAIL (Attach additional sheets to application if needed)
(Maximum of 24 character for both first and last names combined)
Personal ID (must be 4-digit numerical Please check (√) the prompt if desired for each card
Driver First Name Driver Last Name
Daily $
Limit PIN Veh. # and
O dome ter Fu el O nly Fu el w /O il O nly Fu el w /A ll Stor e Prod.
Please check (√) the purchase capabilities desired for each card
VECHICLE CARDS (Attach additional sheets to application if needed)
(Maximum of 14 characters for the vehicle description)
Please check (√) t he prompt if desired for each card
Ve hicle De scription Daily Limit $ Veh
. # a n d O d o m ete r F u el O n ly F u el w /O il O n ly F u el w /A ll S to re P ro d .
Please check (√) the purchase capabilit ies desired for each card
By signing below, I hereby: (1) represent and warrant that I have obtained the legal age of majority and the capacity to enter a binding contract for the company; (2) acknowledge having read and understand this application; (3) request and apply for the account and card(s), which I understand will be governed by the credit agreement and terms provided with this application and/or delivered with the actual fleet cards; (4) certify that all information which I have provided on the application and in connection therewith is true, correct, and complete; (5) authorize Maverik to make credit inquiries about the company to my current and past creditors and to consumer reporting agencies; (6) authorize my current and past creditors and consumer reporting agencies to furnish Maverik with regular or investigative consumer reports about the company; (7) acknowledge that if approved my account will be charged a one-time fee of $12 for time spent verifying my credit history.
Name Title Date
Personal Guarantee: If this account is for an LLC, partnership or a proprietorship, a Partner/Owner must sign this application and the undersigned’s personal credit will/may be used in making a credit decision and they thereby authorize Maverik to obtain a consumer report. Direct inquiries of businesses where the undersigned maintains accounts may also be made.
COMMERCIAL ACCOUNT CREDIT AGREEMENT
(FOR BUSINESS USE ONLY)
BY SIGNING THIS APPLICATION, YOU AGREE WITH MAVERIK COUNTRY STORES, INC. P.O. BOX 9000 AFTON, WY 83110-9902 TO BE BOUND BY ALL THE TERMS OF THIS AGREEMENT IN THE USE OF THE MAVERIK FLEET CARD(S) ISSUED AS A RESULT OF THIS APPLICATION.
1. Commercial Account: This account is for commercial use only, and the account and any CARD(S) issued under the account will not be used for personal, family or household purposes. Billing statements and other reports will not be accurate if the Adventure Club Card is used in conjunction with the Maverik Commercial Fleet Account
2. Payment Terms: The New Balance/Total Amount Owing shown on your monthly statement is due and payable upon receipt of your monthly billing statement. The New Balance/Total Amount Owing includes current purchases, amounts past due, late payment finance charges, and charges for returned checks. Customers also have the option to pay via ACH (Automated Clearing House). ACH payments are simply electronic transfers from one account to another. These payments can be automated/customized to a fleet customer’s preferences.
3. Default, Collection, and Returned Checks: Failure to pay the New Balance/Total Amount Owing constitutes default and entitles us, subject to state law, to demand immediate payment of the full amount outstanding, to stop extending credit and/or to start collection proceedings. You agree to Maverik’s cost of collections, including court costs and reasonable attorneys’ fees as allowed by law. We reserve the right to charge the maximum fee allowed under state law for returned checks. We reserve the right to close the account upon receipt of bad checks.
4. Past-due Balances: You agree to pay a late payment finance charge on past-due balances at the maximum rate permitted under the law of your state of residence (as shown on your billing statement). The New Balance/Total Amount Owing shown on your monthly statement is due and payable upon receipt of your monthly billing statement. A late payment finance charge will be assessed if we do not receive the New Balance/Total Amount Owing within the grace period, ending on the date designated in the statement (the Due Date). The Due Date is 25 days after the billing date.
Late payment finance charges are calculated as follows:
(18%/365)*(Number of days in billing period)*(Average Daily Balance) The average daily balance is calculated by taking the ending balance for each day, taking into account purchases and payments on that day, for all days going back to the last day a payment was made in full. Those daily balances are added together and divided by the number of days. Average daily balances DO include current purchases unless prohibited by the laws of your state of residence.
5. Credit Information: You authorize Maverik to make any credit investigations that Maverik deems appropriate and to request reports from credit reporting agencies in connection with this Agreement or in Connection with any update, renewal or extension of credit. Maverik may furnish information on your account to credit bureaus or others that may properly receive such information.
6. Unauthorized Use: You will be liable for all charges made by both authorized and unauthorized employees, agents, former employees, and former agents, or any other person, whether made before or after you notify us of the loss, theft or unauthorized use of the CARD. This includes:
(a) Any charges made by a person entrusted with a fleet CARD, whether or not you authorized such charges or entrustment;
(b) Any charges made by a member of any employee’s or agent’s family or any adult person residing with any employee or agent and
(c) Any charges made by any person who has obtained a fleet CARD from an employee or agent whether or not the fleet CARD was obtained with the consent of you, your employee or your agent.
7. Change of Terms; Cancellation: Maverik can change the terms of this Agreement at any time. Maverik will notify you of any changes. Retention or use of the CARD(S) after the effective date of the change will constitute acceptance of the new terms. If you do not agree to the change you may end the Agreement by notifying us before the effective date of the change, returning all CARDS and paying what is owed under the terms of the Agreement. Except where the law requires prior written notice, Maverik may at any time limit or terminate the use of the CARD(S) without giving you notice. Any CARD Maverik issues to you remains our property and you agree to return it upon Maverik’s request and pay what you owe under this Agreement. If you authorize someone to use your account, you will recover the CARD(S) if you cancel that person’s authority.
8. Application Information: The information in this agreement is accurate as of _______________________. This information may have changed after that date. To find out what may have changed or for more information visit Maverik’s web site at www.maverik.com. For personal assistance call 800-789-4455, and we’ll be more than happy to assist you.
Maverik Use Only
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