Phone - 888-999-9497   Fax - 608-836-1739
Enter your fleet information using the form below, red stars (  ) denote required fields.
Company name:  
Contact name:  
Contact address:  
State:    Zip:  
Phone:  Ext ( )
Billing contact name:
Contact address:
Billing city:
Billing state:   Billing zip: 
Billing phone:  Ext ( )
Billing fax:
Billing e-mail:
Billed Account (billed monthly, must fill out trade references)
Cash Account (pay at time of service)
Invoice requirements
Tax ID#:
Tax exempt:
Tax exempt #:
** If tax-exempt, must provide copy of tax-exempt certificate. It can be faxed to 608-836-1739.
Years in business:
Number of vehicles:
Number of fleet cards requested:
Business type:
Service area coverage(by zip or state):
Credit reference #1:   Telephone:  
Credit reference #1 contact name:   E-mail:        
Credit reference #1 fax:   Account #: 
Credit reference #2:   Telephone:  
Credit reference #2 contact name:   E-mail:        
Credit reference #2 fax:   Account #: 
Credit reference #3:   Telephone:  
Credit reference #3 contact name:   E-mail:        
Credit reference #3 fax:   Account #: 
If the person filling the form is other than the name mentioned above, please fill in the name below.
First name: Last name: 
Terms & Conditions
This agreement does not require you to have your vehicles serviced with us; however, it does authorize the service center to service your fleets in exchange for timely payments for services rendered. A statement is delivered the first week of every month, and will include all services rendered, including services still outstanding from a previous month. Statements will be delivered via e-mail or fax unless otherwise requested. Payment is expected within thirty (30) days from the statement date and a late charge of two (2) percent or $5, whichever is greater, can be assessed against any past due amounts shown on the statement. An annual inactivity fee of $50 may be assessed on accounts that remain inactive for a period of 24 consecutive months. Written notice to is required upon sale or transfer of any fleet vehicle. Failure to do so will obligate you for any charges after the transaction date. YOU HAVE THIRTY DAYS FROM THE STATEMENT DATE TO NOTIFY OF ANY DISPUTED SERVICES. The customer agrees to pay any and all collection and legal fees incurred by the service center, regardless of whether legal action is taken.

It is agreed and understood that payments shall be remitted to, PO Box 620130, Middleton, WI 53562. The information provided in this application and any other information provided to by the applicant is assumed to be accurate and complete and shall remain the property of You hereby authorize to investigate and confirm your credit experience. Use of your account indicates acceptance of this agreement

** By clicking the submit buttom, you are agreeing to the above terms and conditions.