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Credit Application
Credit Application Form
If you are human, leave this field blank.
Applicant Information
In this Application, “Applicant” means the business entity applying for credit with Finish Line Fuels
Legal Name of Business
*
Fictitious Name of Business (DBA) - or Name to be embossed on cards
*
Type N/A if you have a legal business name
Tax ID
*
Billing Address
*
City
*
State
*
Zipcode
*
County
Fleet Contact
*
Title
*
Email
*
Accounts Payable Contact
*
Email
*
Phone
Office Phone
Mobile
Fax
Email
*
Type of Organization
Sole Proprietor
Partnership
LLP
LLC
Corporation
Non-Profit
Government
Other
Other
State of Formation
*
Years in Business
*
Is the Applicant rated by Dun and Bradstreet?
*
Yes
No
D&B Number
*
If no D&B number, who is the contact at your company to set one up?
*
Business Information
Add additional entries if necessary
Name of Owner, Partner, Operator, Shareholder, Director or Office
*
Title
*
Address
*
Phone
*
Driver's License No.
*
% Interest Owned
*
Add
Remove
Business References
Name
*
Address
*
Phone
*
Add
Remove
Bank References
Name
*
Address
*
Phone
*
Add
Remove
Have you ever declared bankruptcy?
*
Yes
No
If you have declared bankruptcy
Year
*
State
*
Amount of Credit Needed
*
(If request is greater than $50,000 please include most recent financial statements.)
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