Account Application

Corporation, Partnership, and/or Individual(s) exact name *

Number of years this business has been in continual operation?

Address: Street, City, State, Zip *

D.B.A. (if applicable)

Mailing address for Fleet cards *

Contact Us Via Web Form

Phone *

Corporation, Partnership, and/or Individual(s) exact name

Tri-City Fleet and Wash Club

BY Roadrunner Car Washes

Email *

Federal Tax ID Number (Corp.) *

Name of Accounts Payable contact-Name,Email and Phone Number

Corporation, Partnership, and/or Individual(s) exact name

P.O. required

Yes

Name of Principal: Owner/ Officer; Title; Social Security #; Phone

# of Fleet Cards needed *

Name: *

Email: *Check here to receive email updates

Subject: *

Message: *

PO Box 5910, Farmington, NM 87499

505-632-1102

Email: tricityfleetandautowash@gmail.com