Asap Charge Card | ASAP Energy

ASAP Energy Inc. Proprietary Credit Card for Red Dyed Diesel

We are proud to offer the ASAP Energy Proprietary Credit Card to our farm and ranch customers who hold a valid Tax Exemption Card (EXM). Use of the ASAP Proprietary Card will automatically lower the price $.433 cents per gallon.

The ASAP Proprietary Card offers the convenience of paying at the pump and consolidating all of your monthly fuel purchases on one bill. The ASAP Proprietary Card also eliminates the need to go into the store and having the cashier turn on the pump to purchase dyed diesel.

Complete your application today!

We will run your credit to determine eligibility and all ASAP Proprietary Card accounts must comply with the authorization agreement for drafted payments. For immediate answers to all of your questions about the ASAP Energy Inc. Charge Card, please contact: 1-800-530-4300

Please note: To purchase this fuel without tax you must use the ASAP Energy Inc. Proprietary Card with Valid Tax Exemption Permit (EXM) number on file. To comply with Oklahoma Law, the legislation requires users of red diesel to obtain an annual permit from the Oklahoma Tax Commission. Under current law, the use of red diesel is only permitted for off-road vehicles.

"*" indicates required fields

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ASAP ENERGY PROPRIETARY CARD APPLICATION

Title*

Name*

First Last

Company Name*

Trade Name or d/b/a*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Fax

Email*

Date Business Commenced*

State of Formation*

Business Name*

BUSINESS AND CREDIT INFORMATION

Primary Physical Address*

Street Address Address Line 2 City State ZIP Code

How long at current address?*

Fed ID#*

DUNS#*

PRINCIPALS

(owners if proprietorship; all general partners if partnership; all officers with titles if corporation or LLC)

Name

First Last

Title

SS#

Home Address

Street Address Address Line 2 City State ZIP Code

Phone

Name

First Last

Title

SS#

Home Address

Street Address Address Line 2 City State ZIP Code

Phone

Name

First Last

Title

SS#

Address

Street Address Address Line 2 City State ZIP Code

Phone

Has any Principal declared bankruptcy (personally or a business in which s/he was a principal)?:*

Yes

If yes, please state name of company/business (if applicable) and court in which bankruptcy filed:

Bank Name

Phone

Address

Street Address Address Line 2 City State ZIP Code

Savings Acct#

Checking Acct#

Loan Acct#

BUSINESS/TRADE REFERENCES

Company Name

Address

Street Address Address Line 2 City State ZIP Code

Phone

Fax

Type of Account

Company Name

Address

Street Address Address Line 2 City State ZIP Code

Phone

Fax

Type of Account

Company Name

Address

Street Address Address Line 2 City State ZIP Code

Phone

Fax

Type of Account

AGREEMENT – TERMS AND CONDITIONS – GUARANTY

READ BACK AND SIGN

All information provided in support of this credit application and in response to any future requests for information is warranted to be correct and is submitted for the purpose of inducing ASAP Energy, Inc. (“ASAP”) to extend credit to Applicant. Applicant authorizes ASAP (and its representatives or agents) to investigate fully all references and information provided.
The undersigned, individually and on behalf of Applicant:
1. authorizes ASAP to fully investigate all references and information provided, as well as the credit of both Applicant and the undersigned;
2. authorizes those with information about them or their credit to disclose all such information to ASAP; and
3. releases and discharges ASAP and those who provide such information from any claims, causes of action, or damages that allegedly result.
Terms are the same as the (Branded Supplier, if applicable) oil company unless otherwise stated in the Fuel Supply Contract.
Payment will be by electronic funds transfer less any oil company (Branded Supplier, if applicable) credits that ASAP has received from the oil company (Branded Suppler, if applicable).
No additional credit will be extended to past-due accounts unless satisfactory arrangements are made with ASAP’s credit department.
All statements or invoices are deemed correct unless ASAP receives written notice of a dispute within 14 days of the statement/invoice date.
In the event a lawsuit is filed, or the account is placed with third party for collection, all costs, including attorney’s fees and court costs, will be recoverable as part of the amounts owed by Applicant. This agreement is governed by the laws of the State of Oklahoma; venue for any litigation shall be the District Court of Custer County, Oklahoma. Applicant and Guarantor(s) irrevocably and unconditionally waive, to the fullest extent permitted by applicable law, any objection either of them may now have or hereafter have to venue in Custer County and irrevocably and unconditionally submit to the exclusive jurisdiction of and venue in the District Court of Custer County, in any action or proceeding arising out of or relating to this agreement or any aspect of the relationship or business dealings between and among ASAP, Applicant, and/or Guarantor(s). To be clear, Applicant and Guarantor(s) intend to, and do hereby, irrevocably and entirely waive all objections to jurisdiction and venue, including any claim that Custer County is an inconvenient forum.
ASAP may, at any time, file a lien, as authorized by applicable law, to secure payment of any amount owed by Applicant. This is a company policy and not a reflection of Applicant’s credit standing. Applicant will provide ASAP with complete and accurate information for the purpose of preparation, service, and filing of the lien upon request.
This agreement is binding upon Applicant and its successors and assigns. Applicant agrees to notify ASAP, via certified mail, within 10 days of any change in Applicant’s name, legal status, principals or authorized agents, or other material information.
This is the entire agreement between ASAP and Applicant with respect to matters addressed herein. This agreement can only be modified by signed agreement specifically referencing this agreement. Leniency or forbearance by ASAP with respect to any term or condition is not a waiver of any term or condition.
The person(s) signing below represents and warrants that s/he has full authority to execute this agreement on behalf of the Applicant and to fully bind Applicant to the agreements made herein.
The undersigned specifically agree to bind themselves individually to the terms and conditions of this Agreement and personally guarantee all sums due in connection with Applicant’s account. Applicant and the individuals signing below agree to be jointly and severally liable for all amounts owed to ASAP by Applicant. This guarantee is a material part of the credit application and a material inducement to ASAP in extending credit to Applicant.

I WARRANT ALL INFORMATION TO BE TRUE AND COMPLETELY CORRECT. ASAP IS AUTHORIZED TO INVESTIGATE THE UNDERSIGNED AND APPLICANT IN ANY MANNER ASAP DEEMS NECESSARY TO EVALUATE APPLICANT’S AND THE UNDERSIGNED’S CREDIT AND FINANCIAL STABILITY.

SIGNATURES

ON BEHALF OF APPLICANT and AS GUARANTOR*

Title*

Print Name*

SS#*

Date*

AS GUARANTOR*

Print Name*

SS#*

Date*

AUTHORIZATION AGREEMENT FOR PRE-ARRANGED PAYMENTS

I (we) hereby authorize Rick Koch Oil Company. hereafter called COMPANY, to initiate debit or credit entries to my (our) checking account indicated below and the bank named below, hereinafter called BANK, to debit or credit the same to such account.

FINANCIAL INSTITUTION*

BK TRANSIT/ ABA NO.*

BRANCH*

ACCT. NO.*

ADDRESS*

Street Address Address Line 2 City State ZIP Code

TYPE OF ACCOUNT

Checking

Savings

CHECKING ACCOUNT

SAVINGS ACCOUNT

This authority may be terminated upon thirty day’s prior written notification of its termination from me (or either of us) to the COMPANY. A customer has the right to stop payment of a debit entry by notification to BANK prior to charging account. If an erroneous debit entry is initiated by COMPANY to a customer’s account, customer shall have the right to have the amount of such entry credited to such account by BANK, if, within fifteen calendar days following the date on which BANK sent to customer a statement of account or a written notice pertaining to such entry, the customer shall have sent to BANK a written notice identifying such entry, stating that such entry was in error and requesting BANK to credit the amount thereof to such account.

Customer understands that their account will be automatically debited on the 10th of every month (unless this should be a Saturday, Sunday, or Holiday); in such case funds will be debited on the next business day.

The customer will be notified by fax, telephone or mail on the day before the Electronic Funds Transfer (EFT) is processed with the amount to be transferred.

There will be an additional charge of $100.00 for any and all dishonored entries performed by your bank.

Date*

PRINT NAME*

FEI or SS#

COMPANY NAME*

TELEPHONE #*

ADDRESS*

Street Address Address Line 2 City State ZIP Code

TITLE*

SIGNATURE*

TRANSMISSION METHOD: EMAIL ADDRESS*

EFFECTIVE DATE*

FILE*

Max. file size: 250 MB.

Please attach a voided check to this form and mail, fax or email back to: ASAP Energy Inc PO Box 685 Weatherford, Ok 73096 Fax 580-772-8815 | Tammy@asapenergyinc.com

Dyed Diesel can be purchased at the following ASAP General Stores:

Weatherford, Oklahoma
Store Manager: Heather Butler
(580) 772-5618
ASAP General Store #101

Clinton, Oklahoma
Store Manager: Oliva Dezort
(580) 323-0140
ASAP General Store #300

Geary, Oklahoma
Store Manager: Michael Forney
(405) 884-5591
ASAP General Store #301

Thomas, Oklahoma
Store Manager: Glenda Swan
(580) 661-3663
ASAP General Store #302

Hinton, Oklahoma
Store Manager: Tonya Arnold
(405) 542 3544
ASAP General Store #322

Arnett, Oklahoma
Store Manager: Angela Morgan
(580) 885-7526
ASAP General Store #304

Bartlesville, Oklahoma
Store Manager: Ashley Jenkins
(918) 331-3693
ASAP General Store #308
ASAP General Store #311

Duncan, Oklahoma
Store Manager: Dustin Hesbrook
(580) 252-2499
ASAP General Store #313

Enid, Oklahoma
Store Manager: Jeremy Caffey
(580) 701-6268
ASAP, General Store #330

Toll Free 800 - 530 - 4300

580 - 772 - 6076

1501 Airport Road Weatherford, OK 73096

ASAP ENERGY PROPRIETARY CARD APPLICATION

BUSINESS AND CREDIT INFORMATION

PRINCIPALS

BUSINESS/TRADE REFERENCES

AGREEMENT – TERMS AND CONDITIONS – GUARANTY

SIGNATURES

AUTHORIZATION AGREEMENT FOR PRE-ARRANGED PAYMENTS

1501 Airport Road Weatherford, OK 73096

580-772-6076

800-530-4300