If you feel uncomfortable submitting information over the web you can print this form out, complete it and fax to Shell Guam at (671) 649-4353.

Business Name

Contact Person

Address

Phone

Fax

Email

Principle Officer 1

Officer 1 Title

Principle Officer 2

Officer 2 Title

Principle Officer 3

Officer 3 Title

Are company officers prepared to sign personal guarantees if deemed necessary?
Yes No

Business Description

Years of Operation

Business Type
Select Type Sole Proprietorship Partnership Corporation

Monthly Credit Limit
$ (round to nearest $50)

Current Fuel Supplier
Select Supplier Shell Exxon Mobil

Business Credit Reference 1 (local businesses preferred)

Reference 1 Phone

Reference 1 Fax

Business Credit Reference 2

Reference 2 Phone

Reference 2 Fax

Business Reference 3

Reference 3 Phone

Reference 3 Fax

Name of Bank

Checking Account#

Savings Account#

Number of Cars & Vans in Fleet
None about 5 6-10 11-15 15+

Mini-buses
None about 5 6-10 11-15 15+

Buses
None about 5 6-10 11-15 15+

Trucks
None about 5 6-10 11-15 15+

Heavy Equipment
None about 5 6-10 11-15 15+

Monthly Fuel volume for all vehicles/equipment
Premium Unleaded
None < 500 501-1000 1001-1500 1500+

Regular Unleaded
None < 500 501-1000 1001-1500 1500+

Diesel
None < 500 501-1000 1001-1500 1500+

Power Generator
None < 500 501-1000 1001-1500 1500+

Recent Financial statements are required where monthly purchases will exceed $5,000. Please fax statements to (671) 649-4353.

By submitting this application, you authorize your credit references to disclose financial information as requested by Shell in conjunction with this application for credit with Shell Guam, Inc. and its applicable companies.

By submitting this application, you declare all statements herein true and correct to the best of your knowledge.

Your Name

Your Title