Application

Email Address*

Legal Business Name*

DBA Name

Authorized Contact Name*

Title*

Number of Company Vehicles*

Years in Business*

Business Phone*

Mobile Phone*

Address*

City*

State*

Zip Code*

Company Structure*

Tax Identification #*

Average Monthly Expenses*

Requested Monthly Limit*

Requested Payment Terms*

Industry*

Personal Guaranty

By clicking this checkbox, you agree to the Personal Guaranty terms listed below

Guarantor’s Signature *

Full Name*

Date of Birth*

Social Security No.*

Guarantor's Address*

City*

State*

Zip Code*

Date*

Phone #*

By clicking this box, I am confirming that I have read and agreed to all Terms and Conditions found below

Personal Guaranty

In consideration of Card Issuer financing purchases under the Business Charge Account Agreement (as the same may hereafter be modified, extended or amended, “the Agreement”), the undersigned guarantor (“Guarantor”) hereby agrees to unconditionally personally guarantee payment and performance under any account established pursuant to this application, of any obligation of Applicant to Card Issuer or any assignee of Card Issuer, in the event the above Applicant fails to do so. This is a guaranty of payment and not merely of collection. Guarantor agrees to pay, upon demand, any amount owed by Applicant to Card Issuer and due under the Agreement. Card Issuer shall not be required to initiate any action against, nor exhaust any remedies with respect to Applicant or any other guarantor prior to making demand upon Guarantor. Guarantor hereby waives any notices regarding Applicant’s account or this guaranty and agrees that this guaranty shall be applicable until the Agreement has terminated and all amounts due have been paid in full. Guarantor agrees that in the event the account is not paid as agreed, Card Issuer may report Guarantor’s liability for and the status of the account to credit bureaus and others who may lawfully receive such information. Guarantor hereby agrees that Card Issuer may extend the time for payment and release any other security for the agreement without affecting in any way the obligations of Guarantor. Guarantor waives any and all suretyship defenses. Personal credit of Guarantor will be used in making a credit decision and Guarantor hereby authorizes Card Issuer to obtain a consumer credit report of Guarantor. Direct inquiries of businesses where the undersigned maintains accounts may also be made. In the event this application is denied based upon information in a consumer credit report of Guarantor, Guarantor authorizes the Card Issuer to report the reason for the denial to Applicant.

Terms & Conditions

By clicking "Submit Application", Applicant represents and warrants that Applicant is an owner, officer, or partner of the company with the authority to bind the company to the terms of this offer. Applicant authorizes Card Issuer to obtain one or more consumer credit reports on Applicant, in connection with the initial underwriting and any subsequent administration or collection of a Business Charger Card Agreement. In the event Applicant's application is denied based on information in Applicant's credit report, Applicant Authorizes the Card Issuer to report the reason for denial to Applicant.

Applicant Requests a business charge account, if approved for credit, and one or more business cards from Issuer. Applicant agrees to the terms and conditions set forth in the Business Charge Account Agreement provided with this application and/or provided with the business charger card(s). Any use of credit offered by Issuer shall constitute acceptance by Applicant on behalf of Company of the Terms & Conditions, including the Business Charge Card Agreement.

The undersigned applicant/buyer ("Applicant") represents that the information given in this application is complete and accurate and authorizes Issuer to check with credit reporting agencies, credit references and other sources disclosed to confirm information given, and to obtain one or more consumer credit reports on the individual submitting the application.

1) The undersigned applicant/buyer (“Applicant”) represents that the information given in this application is complete and accurate and authorizes Card Issuer to check with credit reporting agencies, credit references and other sources disclosed to confirm information given;

2) Applicant requests a business charge account, if approved for credit, and one or more business charge cards from the card issuer, which is LUKOIL North America LLC (“Card Issuer”);

3) Applicant agrees to the terms and conditions set forth in the Business Charge Account Agreement provided with this application and/or provided with the business charge card(s). Use of any card issued pursuant to this application confirms Applicant’s agreement to said terms and conditions;

4) If this Account is for a partnership or a proprietorship, a partner or principal must sign this application and the undersigned’s personal credit will be used in making a credit decision and they hereby authorize Card Issuer to obtain a consumer report. In the event that this application is denied based upon information contained in a consumer credit report of the undersigned, they authorize the Card Issuer to report the reason for the denial to the Applicant. Direct inquiries of businesses where the undersigned maintains accounts may also be made;

5) Applicant agrees that in the event the account is not paid as agreed, Card Issuer may report the undersigned’s liability for and the status of the account to credit bureaus and others who may lawfully receive such information. If you have any questions regarding this application, please call 1-888-737-7626.

6) By providing the phone numbers below, you authorize us to contact you at any of these numbers regarding this application or any account opened as a result of this application.

Designate the person authorized to receive all charge cards, reports, and other such information we provide from time to time and to take actions with respect to your account and account access. This is also the person designated by your company to provide all fleet vehicle, driver and other information we may request. By signing below, you also (i) designate representatives from your card program sponsor (“Sponsor”) to have access to your account information in order to facilitate customer service and account maintenance requests on your behalf, and (ii) authorize the Card Issuer to accept account maintenance requests and other instructions from Sponsor on your behalf.

INFORMATION SHARING DISCLOSURE: LUKOIL North America LLC, Card Issuer or its affiliates may, to the extent allowed by law, share information disclosed by or generated as a result of this application with each other, and with merchants accepting the card. In addition, information regarding your transactions may be provided to accepting merchants or their service providers to facilitate discounts or other promotional campaigns of interest to you.

Any person signing on behalf of a business attests that the Applicant is a valid business entity, that, if applicable, the execution of this application has been duly authorized by all necessary action of Applicant’s governing body, and that the undersigned is authorized to make this application on Applicant’s behalf.

Personal Guaranty

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