Fleet (Charge) Account Online Application Date * MM DD YYYY Business/Organization Name * Point of Contact for Account * First Name Last Name Point of Contact Email * Please enter an email address that can be contacted upon receipt of the form. We will most likely email this person to confirm account setup. Is there anyone else allowed to make changes to the account? If yes, type name. Billing Email Address * We send all invoices via email, please provide the email address to receive invoices. Business Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Business Phone * Please enter a phone number that can be contacted upon receipt of the form. We will most likely call this number to confirm account setup. (###) ### #### Number of cards requested * Choose the number of washcards you will need on your account or write "unsure" if you are unsure right now. If you already know how you would like the cards assigned, in the below text box, write all of the card holder names you would like applied to individual cards. (ex. John Robinson, Mary George, Tom Bennet, Vehicle 547) Would you like your cards mailed to you or would you like to pick them up at one of our locations? * Mailed I'll pick up Location in which you will be washing most frequently * Feel free to choose multiple locations. Pinedale, WY Riverton, WY (N. Federal location) Riverton, WY (W. Main location) Casper, WY (CY location) Casper, WY (E. 2nd St. location) Wyoming Blvd (Tranquility Way) Douglas, WY Powell, WY Green River, WY Butte, MT Belgrade, MT Laramie, WY Cody, WY Helena, MT How did you hear about our fleet account services? * First Trade Reference - Business/Organization Name * Number of years you have done business with this business/organization? * City, State and Zip * Reference Contact Name * First Name Last Name Email * Phone * (###) ### #### Second Trade Reference - Business/Organization Name * Number of years you have done business with this business/organization? * City, State and Zip * Reference Contact Name * First Name Last Name Email * Phone * (###) ### #### Thank you for submitting your business/fleet account application! An account manager will contact you, please allow at least five business days to be contacted. We appreciate your business!
