Fuel Card Application

Fuel Card Application and Agreement

Recitals

WHEREAS, Applicant Name: (the "Applicant") seeks to obtain one or more fuel charge cards to be issued by Issuer Name: (the "Issuer") for the purpose of purchasing fuel and related services for business operations;

WHEREAS, the Applicant submits the information below to permit the Issuer to evaluate creditworthiness, establish account limits, and impose terms and conditions governing use of fuel cards; and

WHEREAS, upon approval, the Applicant agrees to be bound by the terms and conditions set forth in this Application and Agreement, including payment obligations and restrictions on card use.

Applicant Information

Sole Proprietor    Corporation    LLC    Partnership    Government    Other:

Card Request & Authorized Users

Number of cards requested:    Requested credit limit (total): $

Fuel types to be authorized: Diesel    Gasoline    DEF/AdBlue    Other:

Scope of Use

Describe intended card usage, fleet size, typical monthly gallons, and any special fueling needs. This will be used to determine program configuration and limits.

Payment Terms

The Applicant agrees to pay all charges for purchases made with issued fuel cards in accordance with the following terms.

Billing cycle:

Late payment fee: or % per month on outstanding balance.

Term and Termination

This Agreement commences on Start Date: and continues until End Date: , unless earlier terminated in accordance with this section.

Either party may terminate upon written notice provided at least Notice Period (days): prior to termination. Issuer may suspend or cancel accounts immediately for breach, nonpayment, misuse, or fraud without prior notice.

Confidentiality

The Applicant and Issuer each agree to hold confidential all non-public pricing, program configurations, credit information, and transactional data disclosed by the other party in connection with this Application and Agreement, and shall not disclose such information except (a) as required by law, (b) to their respective affiliates, officers, counsel, or auditors on a need-to-know basis, or (c) pursuant to a written agreement authorizing disclosure. Confidential information shall be protected with reasonable care and for a period of three years from disclosure.

Authorization and Credit Consent

By submitting this Application, Applicant certifies that the information provided is true, complete, and accurate. Applicant authorizes Issuer and its agents to obtain credit reports, verify bank and trade references, and make any investigations necessary to evaluate credit standing and account setup. Applicant further authorizes Issuer to share account performance and payment information with credit reporting agencies and trade references.

Applicant consents to electronic delivery of billing statements, invoices, and notices to the email address provided unless otherwise requested in writing.

Limitation of Liability; Indemnity

Issuer's liability for any claim arising from this Agreement, whether in contract, tort, or otherwise, shall not exceed actual direct damages incurred by Applicant and shall not include incidental, consequential, punitive, or special damages. Applicant shall indemnify and hold Issuer harmless from and against all claims, losses, liabilities, costs and expenses arising from Applicant's misuse of cards, fraudulent activity by cardholders, or Applicant's breach of this Agreement.

Governing Law; Entire Agreement

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflicts of law principles. The parties submit to the exclusive jurisdiction of the state and federal courts located in that State for resolution of disputes.

This Application and Agreement, including any schedules or attachments executed by the parties, constitutes the entire agreement between Applicant and Issuer with respect to the subject matter hereof, supersedes all prior negotiations and understandings, and may be amended only by a written instrument signed by an authorized representative of each party.

Credit and Trade References

Certifications

The undersigned certifies under penalty of perjury that the information provided in this Application is true and correct, that the undersigned is authorized to execute this Application on behalf of the Applicant, and that the Applicant will comply with all terms and conditions set forth herein.

Applicant authorizes Issuer to charge amounts due to the payment method on file and to apply late fees and collection costs, including reasonable attorneys' fees, to recover unpaid balances.

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