Credit Application

Please fill out the following secured form to apply for an invoice or fuel control credit account. If you prefer to fill out by hand please download this form and email to office2@rjrobert.com.

Download Form

Are Purchase Orders required to charge to your account? Yes No

Should we add Sales Tax to your invoices? Yes No

If NO, give Tax Exemption for Registration Certificated Numbers and attach a blanket certificate for each that you are exempt

Purchaser agrees that he assumes full liability for any non-taxed sale which may after be subject to tax:

If this application is for Fuel Control cards and a Fuel Control account, your signature acknowledges that your company and you are 100% responsible for any and all purchases made on the cards, until such time that notice is given to us in writing and receipt of notice given back to you that you are requesting a card or cards to be turned off or locked out.

Is this full-time occupation of owner(s)? Yes No

If owners have other business of other employment (full-time or part-time), please explain