Vessel Information Sheet

VESSEL NAME:		RADIO CALL SIGN:
COUNTRY OF REGISTRY:		PORT OF REGISTRY:
MASTER’S NAME:		OFFICIAL NUMBER:
OWNER NAME/ADDRESS:		INVOICING ADDRESS:

CONTACT:
PHONE:
FAX:
EMAIL:

Credit Card Information (Credit Card Processing Fee: Visa/MasterCard 3%, American Express 3.5%)
CARD TYPE:
CARD NUMBER:
EXP DATE:
NAME ON CARD:
CARD BILLING ADDRESS:
SEC CODE:
TAX NO:
FED ID. (US FLAG VESSELS)


SATCOM 1 PHONE:		SATCOM 1 FAX:
SATCOM 2 PHONE:		SATCOM 2 FAX:
CELL PHONE:		EMAIL:
LANDLINE PHONE:		LANDLINE FAX:


VESSEL LENGTH:	BEAM:	DRAFT:	TONNAGE GROSS:	NET:	NO. CREW:

TANKAGE/FUEL:		US GALLONS:		ARE TANKS SUFFICIENTLY VENTED FOR FAST PUMPING ?
MAX. SPEED VESSEL CAN TAKE FUEL (GPM):			SIZE OF INTAKE PIPELINE & FITTINGS:
LUBE OIL PREFERENCE:

CREDIT APPLICATION

PRINCIPLES AND OWNERS

BANK REFERENCES

VENDOR REFERENCES

PLEASE READ THIS BEFORE SUBMITTING

TERMS AND CONDITIONS: Terms are net 21 days. Invoices not paid within 30 days will be subject to a delinquent charge of 2% per month. Past due accounts forwarded for collection will be subject to any collection costs incurred, including court costs and reasonable attorney fees. If this application is in the name of a corporation, the undersigned agrees to be personally liable for all charges. All deliveries are subject to Global Yacht Fuel, Inc.’s Terms and Conditions, available upon request or for download by clicking here .

I certify that the information supplied herein is correct and that I have read, understand and agree to the terms and conditions above.

BUSINESS NAME	PHONE / FAX

PHYSICAL ADDRESS	EMAIL / URL

	PARENT COMPANY (IF APPLICABLE)

CORPORATION/SOLE PROPRIETORSHIP/JOINT VENTURE	DUNS NUMBER

FINANCIAL INSTITUTION	BRANCH ADDRESS	ACCOUNT NUMBER	PHONE NUMBER	CONTACT NAME

NAME	ADDRESS	CITY, STATE, ZIP	PHONE

NAME	ADDRESS	CITY, STATE, ZIP	PHONE

If you prefer a printable version of this form please click here

CREDIT APPLICATION

PRINCIPLES AND OWNERS

BANK REFERENCES

VENDOR REFERENCES

PLEASE READ THIS BEFORE SUBMITTING