Application for Corporate Fuel Account
Please check one site as your primary supplier:
Athabasca     Bonnyville / Cold Lake    Lac La Biche     Fort McMurray  
  Personal Information  ► (Please check one of the following):    Corporation    Sole Proprietorship    Partnership    
Business Name/Legal Operating Name in Full: *
 *Please Note - if using AFFDA/Offroad number, account name applied for must read the same as legal name under tax-exempt #.
Address: Years in this business:
Type of Business    Telephone: ()     Fax: ()          
Are you a leased Operator?  Yes   No                  Leased To::
  Principal/Owners Information
Name:    Title S.I.N.:
Address: Phone: ()     Fax: ()
Name:    Title S.I.N.:
Address: Phone: ()     Fax: ()
  Accounts Payable Information
Contact:          Telephone: ()
Usual Repayment Terms:    Days                                   Will a Purchase Order Number be Required?  Yes   No
Address:
  Financial Information
Bank # 1:  
Branch Contact Name:                                Telephone: ()        
Bank # 2:  
Branch Contact Name:                                Telephone: ()        
  Credit References (please do not list Banks or Finance Companies)
  Creditor Name and Location (if Applicable) Balance Owing Monthly Payment
   $ $
   $ $
   $ $
I/We,     and   of 

(hereinafter referred to as the corporate customer), apply for credit for the supply of goods, services and materials in accordance with the application for credit currently made. I/We being principal(s) of the corporate customer acknowledge that I/we am/are co-customer(s)/co-purchasers and will be personally responsible jointly and severally with the corporate customer for any and all debts. I/We will jointly and severally indemnify you, and see you paid for your accout with respect to any order now or hereafter made by the corporate customer. I/We further agree to pay your account within your terms of payment net 30 days following purchase (INVOICE), to pay 2% interest and service charges per month (24% per annum) on overdue accounts and I/we assure full responsibility for any costs incurred toward collection of account including legal fees. For the purposes of this credit transaction I /We fully consent and authorize yourselves obtaining any personal credit information through any credit bureau, credit reporting agency, government registry, private registry, or civil enforcement agency.
Dated at: in the province of this day of ,
(name of principal)          (witness)        (name of principal)     (witness)
  For Office Use Only
  Approval Signature   Comments:   Account Number  
  Date Created  
The above listed information is intended only for the purposes listed below, and will only be used when you first become a customer of Cougar Fuels Ltd. This information is used to confirm your identity and credit history; open an account with us; and to receive and provide products and ongoing services to you and may be disclosed to Petro-Canada.
►Submit this Form       ►Print this Form      ► If Fuel Cards required, please fill in another Form after this Submission.