ITL INC - PACIFIC PRIDE CARDLOCK APPLICATION

By filling out this form you are applying for Cardlock access with ITL, Inc, and independent franchisee of the Pacific Pride Commercial Fueling Network. Once you submit your information, your application will be sent to our credit department for review.

IMPORTANT: Do not leave this page while filling out the form or you may lose your information. Once your information is complete, simply click "submit" and the process is complete.

SECTION 1: CURRENT COMPANY CONTACT INFORMATION

Are you presently a Pacific Pride or AmeriNet cardholder?
Yes         No

Email Address (so we can respond to you!):

Full Name of Firm (Purchaser):

Phone Number:                            Fax Number:
    

Mailing Address:

Mailing City, State, Zip

Street Address:

Street City, State, Zip

SECTION 2: CURRENT COMPANY GENERAL INFORMATION

Is your business a
A. Single Entity (not a subsidiary)
B. Partnership
C. Subsidiary of a Parent Company

If you answered C above, please enter the name and address of parent company:

How Long in Business? Years and Months

Corporation State:         Federal ID Number:  

Under what other company name have you operated?


SECTION 3: PREVIOUS EMPLOYMENT INFORMATION

If in business less than two years, please give name, address and length of employment for the last five years:

1)
Business Name:
Business Address:
Business /City/State/Zip:
Business Phone:
Length of Employment: years

2)
Business Name:
Business Address:
Business /City/State/Zip:
Business Phone:
Length of Employment: years

3)
Business Name:
Business Address:
Business /City/State/Zip:
Business Phone:
Length of Employment: years


 

SECTION 4: CURRENT APPLICANT INFORMATION

Name of Applicant/Owner/Officer:  Title:
Spouse Name:
Home Street Address:
Home /City/State/Zip:
Home Phone:

Drivers License Number & State:
Social Security Number:  Date of Birth:
 Name of Nearest Relative Not Living With You:
Relationship:  Phone Number:
 

Have you ever filed bankruptcy?
Yes No
If yes, was it
Personally or Business ?
When did you file:  What City/State:
 


SECTION 5: REFERENCES

Bank Name and Branch:
Bank City & State:
Bank Phone Number:

Current Petroleum Supplier:
Petroleum Supplier Address:
Petroleum Supplier Phone:

Trade Reference 1:
Account Number:  Phone Number:
 

Trade Reference 2:
Account Number:  Phone Number:
 

 

 


SECTION 6: NEW ACCOUNT INFORMATION:

Estimated monthly usage in gallons:  Amount of Credit Desired $

Accounts Payable Contact Name:
Accounts Payable Phone Number:

Person to Contact to Make Arrangements for Cards:
Phone Number:  Cell Phone Number:
 


SECTION 7: ADDITIONAL TERMS AND CONDITIONS:

1.       Cardlock fueling access cards are used to activate fueling dispensers at individual Pacific Pride/PrideNet/AmeriNet fueling network locations.  These access cards are NOT credit cards.  The issuance of credit by ITL is independent of the process for issuing a network fueling access card.

2.       Purchaser shall be responsible for all purchases by Purchaser or its employees or any other persons using network cardlock cards issued to Purchaser, regardless of whether use by any other person is unauthorized or fraudulent unless those cards are reported immediately as lost, stolen, or misused.  Lost, stolen, or misused cards should be reported by calling ITL Cardlock Billing at (323) 562-3230 AND by faxing a “request to invalidate” the specific lost, stolen or misused cards to ITL Cardlock Billing at (323) 560-1170.  Cards will be invalidated throughout the Pacific Pride network by 11:59PM on the date of notification.

3.       If there is any change in the ownership of Purchaser or if substantially all of the assets of Purchaser are sold, Purchaser shall promptly notify Supplier of such sale and Supplier shall have a lien on all the assets of Purchaser and a lien on the proceeds of such sale to secure payment of all outstanding sums owed to the Supplier.

4.       Purchaser represents that it and any person using the Cardlock cards delivered to Purchaser are and shall be aware of the proper use of the Cardlock system and shall use safe practices in compliance with the regulations of the local fire code in the handling of the fuels dispensed from the cardlock system. The Purchaser agrees to indemnify and hold Supplier harmless from any claims and costs including, but not expressly limited to, loss for bodily injury and property damage which may be occasioned by the negligence of misuses of the cardlock system by the purchaser or any person using the cardlock cards delivered to the Purchaser hereunder.

5.       Supplier shall use its best efforts to maintain the Cardlock system in good working order and condition at its expense provided, however supplier shall not be responsible for any damage of loss which may result from its failure to provide fuel or the failure of the cardlock system in any manner whatsoever. Purchaser agrees that it and any person using the cardlock cards delivered to the Purchaser shall promptly notify supplier of any malfunctioning of the cardlock system of which Purchaser of such person is aware.

6.       Purchaser’s right to purchase fuel through the cardlock system may be terminated immediately upon any breach of any of the terms hereof or of any other agreement with supplier. Upon termination, Purchaser agrees to immediately surrender all cardlock cards issued to Purchaser and to immediately pay all outstanding sums owed to supplier. Supplier shall refund any deposit to Purchaser when all cards are returned and all amounts owing to supplier are paid in full.

7.       The card deposit of $25.00 will not be refunded after three years. Normally during that time, cards will be reissued at least once and accounts restructured as business changes.

8.       A $100.00 handing fee will be charged for all checks returned from the bank for any reason.

 

Default Agreement. Should Purchaser default on any obligation under this agreement and the Supplier refers this account to his attorney for collection and/or legal action, Purchaser agrees as follows: to pay the principal due, attorney fees and all costs of any nature incurred by the Supplier to pursue the delinquent obligation. In addition, 15% of the principal amount due shall be added to the principal as liquidated damages to cover any an all-additional expenses to Supplier. In the event of a dispute or litigation between the parties, it is hereby agreed that jurisdiction and venue shall vest in Los Angeles County, California, Central District or Orange County, California, Central District at the sole discretion of the Supplier. All other venues are hereby expressly waived.

I agree to these Terms & Conditions

Signed by: Title

Print Name:   Date:

PRINT AND FAX THIS REPORT TO (323) 560-1170