I/we herewith make application to ITL Inc (hereinafter “Vendor”) for credit and/or to update and reconfirm of our existing account and balance. The undersigned gives and grants Vendor, or their agent, permission to verify or re-verify all information stated herein at any time. I/we hereby agree that all credit granted and/or extended shall be paid timely in accordance with Vendor’s normal terms. I/we affirm that all information supplied is true and correct.

IMPORTANT: Do not leave this page while filling out the form or you may lose your information. Once your information is complete, simply click "submit" and the process is complete.

Email Address (so we can respond to you!):        

Full Name of Firm:    

Billing Address:        

City, State, Zip       

Phone Number:            Fax Number: 

Business Name (DBA):

Street Address:       

City, State, Zip       

Fed ID No                       CA Resale No.

Type of Business              Years in Business?

Is your business a
A. Single Entity (not a subsidiary)                  B. Partnership       

C. Corporation      State           

D. Subsidiary of a Parent Company. Please enter the name and address of parent company:


Under what other company name have you operated?


Name of Applicant/Owner/Officer: Title:
Spouse Name:
Home Street Address:
Home /City/State/Zip: Home Phone:

Drivers License Number & State:
Social Security Number: Date of Birth:
 Name of Nearest Relative Not Living With You:
Relationship: Phone Number:

Have you ever filed bankruptcy?
Yes No
If yes, was it
Personal or Business ?
When did you file: What City/State:

Bank Name and Branch:
Bank City & State: Account #
Bank Phone Number:

Current Petroleum Supplier 1: How Long?
Current Petroleum Supplier 2: How Long?

Trade Reference 1:
Account Number: Phone Number:
Trade Reference 2:
Account Number: Phone Number:

Estimated monthly usage in gallons:

Accounts Payable Contact Name:
Accounts Payable Phone Number:



Default Agreement

Should Purchaser default on any obligation under this agreement and the Supplier refers this account to his attorney for collection and/or legal action, Purchaser agrees as follows: to pay the principal due, attorney fees and all costs of any nature incurred by the Supplier to pursue the delinquent obligation. In addition, 25% of the principle amount due shall be added to the principle as liquidated damages to cover any an all-additional expenses to Supplier. In the event of a dispute or litigation between the parties, it is hereby agreed that jurisdiction and venue shall vest in either Los Angeles County, California, Central District or Orange County, California, Central District at the sole discretion of the Supplier. All other venues are hereby expressly waived.

I agree to these Terms & Conditions

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Signed by:     Title   

Print Name:     Date: 


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