5602 - 54th Avenue
Bonnyville, Alberta
T9N 2N3
Fax (780) 826-3040
Fuel Account Information/Card Requirements
  Current Fuel Supplier:
FUEL CARDS REQUIRED
Cards How Many?
  Previous Fuel Supplier:
  Estimated Monthly Purchases in Dollars:  $ Clear Gas
  Credit Limit Required (30 day terms): $ Clear Diesel
Would like   more cards with same products as above   
  Dyed Product Fuel Requirements **MUST HAVE TAX EXEMPT NUMBER TO PURCHASE!
  AFFDA # 01 If numbers end in anything other
than 01 or 06, number is expired
FUEL CARDS REQUIRED
Cards How Many?
  Offroad #    A  06
  ** PLEASE NOTE ** - above number MUST be under the same
  name as account name applied for as the other form you submitted!		 Dyed Gas
Dyed Diesel
  Cards WILL NOT be issued if above information is not listed All Products
Would like   more cards with same products as above   
Petro-Pass Cardlock Agreement
  Bonnyville
5602 - 54 Ave
826-3043		 Cold Lake
5011 - 47 Ave
826-3043		 Lac La Biche
Hwy 55
623-4560		 Athabasca
5306 - 51 Ave
673-2342		 Fort McMurray
365 MacAlpine Cres.
743-2459		  

This application is to ensure the agreement between Cougar Fuels Ltd., a body corporate incorprated under the laws of Alberta and the name as received (hereinafter called the "customer") per reverse side application:
made this day of year of located at
anyone of the above Cougar Fuels Ltd. site locations (hereinafter called the "Vendor")
In consideration of Vendor allocating to Customer the card of cards set out below, to be used on Vendor's electronically operated fuel dispensing system network (hereinafter called "Vendor facilities") for the purpose of supplying Customers with Diesel Fuel and/or Gasollines (hereinafter collectively called the "Fuel"), Customer covenants and agrees with Vendor with the terms and conditions set out along with customer fuel cards.

In witness whereof the party hereto have executed this Agreement as of the date first above written.
(customer name)                 (witness)
FOR OFFICE USE ONLY  /  FUEL CARD LISTING
To activate fuel cards, please contact our bonnyville office during business hours
DO NOT DESTROY CARDS:   All cards are the property of the Vendor and must be returned on demand. Customer herewith agrees to pay Vendor $50.00 for each card not returned with 30 days of demand or for replacement due to loss of card or misplaced card.
  For security purposes, please provide a one-word passcode which will be used for activation
Card Number Products on Card Pin Number Customer Account Date
                 
                 
                 
                 
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