Consolidate Your Fueling and Maintenance with the
Fleet Card Program that Gives You the Most
Save Time Fleet Card
and Money! Application
Savings, Control, and Convenience.
CONVENIENCE
The Qik-n-EZ Fleet Card is accepted at all Qik-n-EZ locations. Plus,
if you need to fuel outside our area, you can choose the Qik-n-EZ
Universal Card for acceptance at more than 90% of retail fueling
locations nationwide, anywhere Wright Express is accepted. You
can also choose to have either card accepted at more than
45,000 service locations for vehicle maintenance and repair.
The Qik-n-EZ Fleet Card is more than a charge card. It’s the fleet management tool you’ve been looking for…
the program that gives you the information you need for better control and savings. Our single card can replace your
current fuel credit cards, offer greater flexibility and give you the tools to create policies to reduce unauthorized purchases.
T I M E S AV I N G S
Comprehensive monthly and year-to-date reporting helps you
monitor purchases and vehicle efficiency. Download PDF reports
or receive in the mail.
ONLINE SERVICES
Powerful online tools allow you to closely manage expenses.
PERFORMANCE TRACKING
Cost per mile and miles per gallon are calculated for you so you
know how well your vehicles are performing.
M O N E Y - S AV I N G R E B AT E S
CONTROLLED SPENDING
TA X E X E M P T I O N & R E P O R T I N G
For qualified fleets we bill net of applicable taxes due when
permissible.
Apply Today!
QnEZ.APPBRO(1/08)
NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES
A P P LY N O W !
Simply complete the attached account application and fleet information form. Then mail the
postage-paid form or fax to 1-800-374-4568. Or, if you prefer, call us at 1-866-706-5554
and we’ll be happy to answer any questions or take your application information right over the phone.
CONTROL
You’ll know where and when every purchase was made
PORTLAND ME
Online services make it easy for you to cancel lost or stolen cards immediately, pay your
invoice, and save your reports in PDF format.
Friendly, trained representatives are also available – 24 hours a day, 7 days a week – to assist
drivers and managers with questions.
SECURITY
Driver identification numbers help prevent unauthorized fueling.
PERMIT NO. 92
SUPERIOR SERVICE
BUSINESS REPLY MAIL
Purchase Controls give you the online tools to help prevent unauthorized purchases. You decide
how you want your cards to be used based on your unique vehicle and driver purchasing needs. If
a transaction falls outside any of your limits, our system is designed to decline the transaction,
subject to the limitations described online.
Purchase Alerts allow you to keep your drivers on schedule, while staying alert to possible
problems. You’ll receive an email when a transaction falls outside your purchase guidelines, so
you can decide if any action is required.
Additional terms and fees may apply to some program features. Ask a sales representative for details.
POSTAGE WILL BE PAID BY ADDRESSEE
ONLINE PURCHASE CONTROLS
QIK-N-EZ FLEET CARD PROGRAM
PO BOX 639
PORTLAND ME 04104-9814
When your drivers use the card, they must provide an authorized driver ID number plus the
vehicle’s odometer reading. Together with the information encoded in the card’s magnetic stripe,
we can tell you who bought what, where, when and for how much. We even tell you how well your
vehicles are performing by reporting the cost per mile and miles per gallon.
With our Exception Reporting you’ll also be able to quickly and easily identify purchases that are
outside your policies, such as fueling on weekends or holidays or fill-ups with premium fuel.
FIRST-CLASS MAIL
C O S T C O N T R O L A N D S AV I N G S
Complete and mail the attached postage-paid application
or call 1-866-706-5554.
INCREASED SECURITY
Comprehensive Reporting
does the accounting for you.
Y O U R S E C U R I T Y A N D S AV I N G S T O O L . . .
With our system, each vehicle is assigned a card and each driver is assigned a unique identification number – one
cannot be used without the other. Drivers enter the current odometer reading of the vehicle at the time of purchase
along with the identification number. With all this information captured electronically, we bring you the ultimate control
in vehicle management.
Plus, you’ll save money by cutting down on administrative expenses. Eliminate
the time spent sorting through cash receipts and credit card slips. You get all
this convenience, control and savings for a one-time setup fee of $40.00
per account and, for each Universal card, a $2.00 monthly card fee.
SEC URITY - You know who
buys what, where and when.
CONTROL - Reduce costs
EXCEPTIONS Trouble spots are flagged,
helping to prevent abuse.
by managing fuel types.
ONLINE SERVICES
View, print and save reports in PDF
format. With just a few mouse clicks you
can add or delete drivers and cards.
Eliminate the burden of writing checks with
online payment.
C O N V E N I E N C E - Easily
track expenses by type.
V E H I C L E P E R F O R M A N C E - Both miles
per gallon and cost per mile are calculated so
you can track vehicle performance at a glance.
C O S T S A V I N G S - Administrative time
is reduced and fiscal reporting is easy
with monthly and year-to-date reporting.
For more information or
to sign up, call 1-866-706-5554.
Our bank complies with Section 326 of the USA PATRIOT Act which requires all financial institutions to obtain, verify, and record information that identifies each company or person who opens an account. What
this means for you: when you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other
identifying documents for your business.
QIK-N-EZ FLEET CARD ACCOUNT 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 business charge account, if approved for credit, and one or more business charge cards from the card issuer, which is Wright Express Financial Services Corporation (“Card Issuer”); 3) Applicant agrees to the terms and
conditions set forth in the Business Charge Account Agreement provided with this application and/or provided with the business charge card(s). 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 report. In the event
that this application is denied based upon information contained in a consumer credit report of the undersigned, they authorize the Card Issuer to report the reason for the denial to the Applicant. Direct inquiries of businesses where the undersigned maintains
accounts may also be made; 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. If
you have any questions regarding this application, please call 1-866-706-5554.
Full Legal Company Name of Applicant/Buyer
Phone #
Fax #
(
)
(
To set up your account, we need the vehicle and driver information
completed below. Please attach a separate sheet if you need additional
space. If you have any questions, please call 1-866-706-5554.
)
Write company name as you wish it to appear on cards. Limit of 20 characters including
spaces. Unless specified, no company name will appear on cards.
DBA or AKA
Subsidiary of
Applicant’s Taxpayer ID # (TIN, FEIN or SSN)
Headquarters Name, Physical Address and Phone # (Do not include PO Box)
Billing Contact
Fleet
Information Form
SIC Code or Type of Business
Billing Address
City
Principal(s)/ Authorized Officer(s)
State
Zip + 4
Title(s)
CARD DESCRIPTIONS
For each card, provide the description that will appear on your
reports. All cards are accepted at Qik-n-EZ Stations. If you want a
card accepted at 90% of U.S. retail fuel locations for an additional
fee of $2 per card, per month, check the Universal box.
DESCRIPTION FOR REPORTING
(For example, year, make and model)
In Business Since (yyyy)
Year of Incorporation (yyyy)
Average Monthly Fuel Expenditures
$
Complete this section accurately. Check one:
Fiscal Year Start (mm)
Average Monthly Service Expenditures
$
Corporation
Partnership
LLC
Proprietorship
Choose Card Type(s)
All Fuel Only
All Unrestricted
1. ______________________________________
Some of Each
2. ______________________________________
Number of Vehicles
3. ______________________________________
PC or PA
Designate the person authorized to receive all charge cards, reports, and other such information we provide from time to time and to take actions with respect to your account and account access. This is also the person designated by your
company to provide all fleet vehicle, driver and other information we may request. By signing below, you also (i) designate representatives from your card program sponsor (“Sponsor”) to have access to your account information in order to
facilitate customer service and account maintenance requests on your behalf, and (ii) authorize the Card Issuer to accept account maintenance requests and other instructions from Sponsor on your behalf.
Authorized Contact Name
Title
Fax #
Phone #
(
Mailing Address (if different from billing address)
Check here for
UNIVERSAL card
)
(
City
State
)
Zip+4
4. ______________________________________
5. ______________________________________
6. ______________________________________
7. ______________________________________
8. ______________________________________
Email Address
9. ______________________________________
Check here if business is exempt from motor fuels tax. (Sales representative will provide further details.)
INFORMATION SHARING DISCLOSURE: Qik-n-EZ, Card Issuer or its affiliates may, to the extent allowed by law, share information disclosed by or generated as a result of this application with each other, and with merchants accepting the
card. In addition, information regarding your transactions may be provided to accepting merchants or their service providers to facilitate discounts or other promotional campaigns of interest to you.
10. ______________________________________
AUTHORIZED SIGNATURE REQUIRED
Any person signing on behalf of a business attests that the Applicant is a valid business entity, that, if applicable, the execution of this application has been duly authorized by all necessary action of Applicant’s governing body, and that the
undersigned is authorized to make this application on Applicant’s behalf.
Signature
Date
Print Name
Title
DRIVER NAMES
Drivers may choose their own 4-digit Driver ID #. Please assign #
beside name or leave blank if you wish our computer to assign.
X
Complete the Personal Guaranty below if this account is for: a business incorporated less than three years, a partnership, a proprietorship, professional corporation or association, or limited liability company.
PERSONAL GUARANTY (SEE ABOVE)
In consideration of Card Issuer financing purchases under the Business Charge Account Agreement (as the same may hereafter be modified, extended or amended, “the Agreement”), the undersigned guarantor (“Guarantor”) hereby agrees to
unconditionally personally guarantee payment and performance under any account established pursuant to this application, of any obligation of Applicant to Card Issuer or any assignee of Card Issuer, in the event the above Applicant fails to do so.
This is a guaranty of payment and not merely of collection. Guarantor agrees to pay, upon demand, any amount owed by Applicant to Card Issuer and due under the Agreement. Card Issuer shall not be required to initiate any action against, nor
exhaust any remedies with respect to Applicant or any other guarantor prior to making demand upon Guarantor. Guarantor hereby waives any notices regarding Applicant’s account or this guaranty and agrees that this guaranty shall be applicable
until the Agreement has terminated and all amounts due have been paid in full. Guarantor agrees that in the event the account is not paid as agreed, Card Issuer may report Guarantor’s liability for and the status of the account to credit bureaus and
others who may lawfully receive such information. Guarantor hereby agrees that Card Issuer may extend the time for payment and release any other security for the agreement without affecting in any way the obligations of Guarantor. Guarantor
waives any and all suretyship defenses. Personal credit of Guarantor will be used in making a credit decision and Guarantor hereby authorizes Card Issuer to obtain a consumer credit report of Guarantor. Direct inquiries of businesses where the
undersigned maintains accounts may also be made. In the event this application is denied based upon information in a consumer credit report of Guarantor, Guarantor authorizes the Card Issuer to report the reason for the denial to Applicant.
Guarantor’s Signature
Print Name
Date of Birth
Social Security No.
Date
Phone #
(
Sales Code
3. ____________________________________
4. ____________________________________
6. ____________________________________
)
7. ____________________________________
FOR OFFICE USE ONLY
Opportunity Number
2. ____________________________________
5. ____________________________________
X
Guarantor’s Residential Address - street, city, state, zip (Do not include PO Box)
1. ____________________________________
Coupon Code
Account Number
QEZ
0496
Instructions: Complete Application and Fleet Information Form, tear along perforation and fold so our address appears on outside.
Tape closed and drop in mail. To speed processing, fax to 1-800-374-4568.
8. ____________________________________
9. ____________________________________
10. ____________________________________