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Fleet Account / Loyalty Card

Fleet Account & Loyalty Card Application

Individual and/or Business Name

Accounts Payable Contact

Address

City

State / Province

Postal / Zip Code

Same as address

Billing Email Address

Contact Phone Number

Anticipated Fuel Type(s)

Diesel Premium Gasoline Regular Gasoline DEF

Number of Cards Requested

Please choose one of the following options, please note that both options come with a discount on fuel

I would like a Fuel Yukon loyalty card I would like a Fuel Yukon fleet card charge account

Requested Credit Amount $

Credit accounts are available only to customers who purchase at least $500 of fuel per month on average and provide credit references. Payment is required within 30 days of the last day of the invoiced month. Fuel Yukon will suspend any account with past due invoices.

CVV

It is the customer's responsibility to ensure the processability of their credit card at all times. Fuel Yukon will attempt to process the card and note if it is declined, but it is ultimately the client's obligation to ensure there are sufficient funds on the card.

Credit Reference #1

Company Name

Email address or Phone Number

Credit Reference #2

Company Name

Email address or Phone Number

Thank you for submitting an inquiry into the charge and discount accounts at Fuel Yukon. The main office processes all account approvals, and someone from the main office will contact you within 3 business days of submission.

Charge Cards and Discount Cards can be used at the following locations:
* 2 Burns Rd (Airport Chalet)
* 91317 Alaska Highway (New North location)

First Name

Last Name

Signature

Drivers License Number