Online Application
To apply, simply fill out the following form with correct information and click Submit.   Please allow five business days for processing.

Section 1

* Indicates Required Field.

*Legal Company Name:
DBA:
*Billing Address:
*City, State, Zip:
Delivery Address:
City, State, Zip:
*Business Phone:
Fax:
*Company Contact:
*Type of Business:

Owner/Partner Name
First, MI, and Last Name:
Social Security #:
Address:
City, State Zip:
Bank Of Reference
Type of Account:
Account #:
Bank Name and Phone #:
Bank Credit Line Account #:
Bank Name and Phone #:
Gas Usage
*Monthly Gas Usage ($):
*Diesel Usage ($):
*Billing Cylce Requested:
*Invoice Sort:
Internet Access
First and Last Name:
Email Address:
Password:
Section 2
*Driver Name or Vehicle Description Pin # Vehicle #: LIMITED: IF NOT RESTRICTED IN CATEGORY ENTER NONE
Grade of Fuel # Trans/Day

ALL CHARGES ARE DUE 10 DAYS FROM THE INVOICE DATE.  A finance charge of 1.5 % (apr 18%) will be added to invoices more than 30 days old.  In the event any BALANCE of any INVOICE is NOT PAID within 30 days of the date of the invoice, the right to purchase on chrdit may be terminated or limited at the discretion of Fleet RiteNet.