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Shell Fleet Card - Application

Please complete the application form below. If you feel uncomfortable submitting information over the web please print this form, complete it and fax to Shell Guam on (671) 649 4353

x Business Name

x Contact Person

x Address

x Phone

x Fax

x Email

x Principle Officer 1

x Officer 1 Title

Principle Officer 2

Officer 2 Title

Principle Officer 3

Officer 3 Title

x Are company officers prepared to sign personal guarantees if deemed necessary

Yes
No

Business Description

Years of operation

x Business Type

Monthly Credit Limit (to nearest $50)

Current Fuel Supplier

x Business Credit Reference 1 (local businesses preferred)

x Reference 1 Phone Number

x Reference 1 Fax Number

x Business Credit Reference 2

x Reference 2 Phone Number

Reference 2 Fax Number

x Business Credit Reference 3

Reference 3 Phone Number

Reference 3 Fax Number

x Name of Bank

Checking Account Number

Savings Account Number

Please provide details of your fleet.

Number of cars and vans in your fleet

Number of Mini buses

Number of Trucks

Number of Heavy Equipment

Please provide details of monthly fuel volume for all vehicles.

Premium Unleaded Volume

Regular Unleaded

Diesel

Power Generation

Recent financial statements are required where monthly purchases will exceed $5,000. Please fax statements to (671) 649 4353.

By submitting this application, you authorize your credit referees to disclose financial information as requested by Shell in conjunction with this application for credit with Shell Guam, Inc. and its applicable companies.

By submitting this application, you declare all statements herin true and correct to the best of your knowledge.

x Your Name

x Your Ttile

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Shell Fleet Card - Application