Clifford Fuel Fleet Card

Cliff’s Local Market offers its own Cliff’s Local Market business fleet cards to businesses and municipalities who have multiple vehicles. The business gas cards can be used at any of our locations which is convenient to the customer. We offer customized billing options, which may include driver information, vehicle identification, odometer readings and more. Invoices can be sent weekly or monthly to customers approved for credit. For more information about our business gas cards please contact John Lytwynec.

Please fill out the application below to apply for a Business Gas Card or click here to download a printable PDF of the application.

  • Fleet Card Credit Application

    1. The undersigned applicant/buyer (“Applicant”) represents that the information given in this application is complete and accurate and authorizes Card issuer to check with credit reporting agencies, credit references and other sources disclosed to confirm information given.
    2. Applicant requests a charge account, if approved for credit, and one or more charge cards from the card issuer.
    3. Applicant agrees to the terms and conditions set forth in the Charge Account Agreement. Use of any card issued pursuant to this application confirms Applicant’s agreement to said terms and conditions.
    4. If this Account is for a partnership or a proprietorship, a partner or principal must sign this application and the undersigned’s personal credit will be used in making a credit decision and they hereby authorize Card issuer to obtain a consumer credit report.
    5. Applicant agrees that in the event the account is not paid as agreed, Card issuer may report the undersigned’s liability for and the status of the account to credit bureaus and others who may lawfully receive such information.
  • Business Credit Information

  • TIN, FEIN, or SSN
  • MM slash DD slash YYYY
  • In Gallons
  • Business Bank

  • Trade References

  • Designation of Contact Person/Recipient of Reports

  • Tax Exempt Municipality

    Must provide written statement of municipality status & Federal ID Number
  • Authorization Signature Required

  • MM slash DD slash YYYY