Account Setup

Welcome! Let's set up your account with America's Energy Inc.

What products are you interested in purchasing?

Select all that apply.

Bobtail Fuel < 5,000 gallons

Transport Fuel > 5,000 gallons

Lubricants Oil, grease & fluids

DEF Diesel Exhaust Fluid

Chemicals Industrial chemicals

Racing Fuel VP Racing products

Account Setup

Complete all sections to apply for a credit account with America's Energy Inc.

1 Business

2 Ownership

3 Banking

4 References

5 Terms

6 Guarantee

7 Payment

8 Review

Business Information

Please provide your company's legal and contact information.

Legal Business Name *

DBA / Trade Name (if different)

Credit Amount Requested *

Business Address *

City *

State *

ZIP Code *

Business Phone *

Business Email *

Website

Federal Tax ID (EIN) *

Upload W-9 Form *

Click to upload your W-9 or drag and drop PNG, JPG, or PDF (max 5MB)

Please upload a completed W-9 form for your business.

Entity Type *

State of Incorporation *

Year Business Established *

SIC Code 4-digit Standard Industrial Classification code

Number of Employees *

Industry / Entity Type *

Main Business Activity / Description *

Accounts Payable Contact Name *

Accounts Payable Email *

Accounts Payable Phone *

Sales Tax Exempt? *

Sales Representative *

Ship-To / Delivery Addresses

Same as business address

Add all locations where products should be delivered.

Ship-To Address #1

Location Name *

Street Address *

City *

State *

ZIP Code *

Contact Name *

Contact Phone *

Delivery Instructions

Ownership / Principal Information

Please provide information about the business owner(s) or principal(s).

Owner / Principal #1

Full Legal Name *

Title *

Date of Birth *

Home Address *

City *

State *

ZIP Code *

Cell Phone *

Home Phone

Email Address *

Ownership % *

Personal Net Worth * Approximate personal net worth

Driver's License # *

DL State *

Social Security Number * Format: ###-##-####

Previous Address (if at current address less than 2 years)

Have you filed for personal bankruptcy? *

If yes, Chapter

Banking Information

Please provide your primary bank account details for credit verification.

Bank Name *

Bank Address *

City *

State *

ZIP Code *

Bank Contact Name

Bank Phone *

Account Type *

Account Number * Your account number will be verified against the voided check you upload

Years at This Bank *

Trade References

Please provide at least 3 trade references (suppliers you currently do business with on credit terms).

Trade Reference #1

Company Name *

Contact Name *

Phone *

Email *

Your Account #

Trade Reference #2

Company Name *

Contact Name *

Phone *

Email *

Your Account #

Trade Reference #3

Company Name *

Contact Name *

Phone *

Email *

Your Account #

Trade Reference #4 (Optional)

Company Name

Contact Name

Phone

Your Account #

Terms & Conditions

Please read and acknowledge the following terms and conditions.

BUYER AGREES THAT ALL PURCHASES FROM AMERICA'S ENERGY, INC. (AEI) ARE SUBJECT TO THE FOLLOWING TERMS AND CONDITIONS:

1. ACCEPTANCE OF TERMS: By submitting this credit application and accepting credit from AEI, Buyer agrees to be bound by these Terms and Conditions for all purchases. No terms or conditions stated by Buyer in any purchase order or other document shall apply unless specifically agreed to in writing by an authorized officer of AEI.

2. PAYMENT TERMS: Payment is due within the credit terms specified on each invoice (Net 7, Net 15, or Net 30 days from invoice date). All payments must be received by AEI on or before the due date. Payment terms are subject to credit approval and may be modified or revoked at AEI's discretion.

3. LATE PAYMENT CHARGES: Any payment not received when due shall accrue interest at the rate of one and one-half percent (1.5%) per month (18% per annum) or the maximum rate permitted by law, whichever is less, from the due date until paid in full.

4. DEFAULT: Buyer shall be in default if: (a) any payment is not made when due; (b) Buyer becomes insolvent or bankrupt; (c) Buyer makes an assignment for the benefit of creditors; (d) a receiver is appointed for Buyer's business or property; or (e) Buyer breaches any other term of this agreement.

5. SECURITY INTEREST: Buyer grants to AEI a purchase money security interest in all products sold by AEI to Buyer, and all proceeds thereof, until full payment is received. Buyer authorizes AEI to file financing statements without Buyer's signature to perfect this security interest.

6. COLLECTION COSTS: If Buyer's account becomes delinquent and is referred for collection, Buyer agrees to pay all costs of collection including, but not limited to, reasonable attorney's fees, court costs, collection agency fees, and other expenses incurred in collecting the debt.

7. CREDIT REVIEW AND MODIFICATION: AEI reserves the right to review Buyer's credit at any time and to modify, suspend, or terminate credit privileges without prior notice. AEI may require updated financial information from Buyer at any time.

8. PRICES AND AVAILABILITY: All prices are subject to change without notice. Product availability is not guaranteed. AEI reserves the right to allocate products among customers during periods of short supply.

9. TITLE AND RISK OF LOSS: Title to and risk of loss for all products shall pass to Buyer upon delivery by AEI or its carrier to the delivery location specified by Buyer. Buyer is responsible for inspecting products upon delivery and noting any shortage or damage on the delivery receipt.

10. CLAIMS AND RETURNS: Claims for shortages or defects must be made in writing within five (5) business days of delivery. Products may not be returned without prior written authorization from AEI. Authorized returns may be subject to a restocking fee of up to 25%.

11. WARRANTIES: AEI makes no warranties, express or implied, regarding the products sold, including any implied warranties of merchantability or fitness for a particular purpose. Buyer's sole remedy for any product defect shall be replacement of the defective product or refund of the purchase price, at AEI's option.

12. LIMITATION OF LIABILITY: AEI's liability for any claim arising from the sale of products shall not exceed the purchase price of the products giving rise to the claim. AEI shall not be liable for any consequential, incidental, special, or indirect damages.

13. FORCE MAJEURE: AEI shall not be liable for any failure or delay in performance caused by circumstances beyond its reasonable control, including but not limited to acts of God, war, terrorism, civil unrest, labor disputes, supply chain disruptions, or government regulations.

14. GOVERNING LAW AND VENUE: This agreement shall be governed by the laws of the State of Arizona without regard to conflict of law principles. Any legal action arising from this agreement must be brought exclusively in the state or federal courts located in Maricopa County, Arizona. Buyer consents to the jurisdiction and venue of such courts.

15. CREDIT INVESTIGATION: Buyer authorizes AEI to investigate Buyer's credit history, obtain consumer and business credit reports, and verify information provided in the credit application. Buyer authorizes all trade references, banks, and other creditors to release credit and financial information to AEI.

16. ENTIRE AGREEMENT: These Terms and Conditions, together with the credit application and any applicable invoices, constitute the entire agreement between Buyer and AEI regarding credit purchases. No modification shall be effective unless in writing and signed by an authorized officer of AEI.

17. SEVERABILITY: If any provision of this agreement is found to be invalid or unenforceable, the remaining provisions shall continue in full force and effect.

18. WAIVER: No waiver by AEI of any breach of this agreement shall constitute a waiver of any other breach. AEI's failure to enforce any right under this agreement shall not constitute a waiver of that right.

Applicant Signature

By signing below, I acknowledge that I have read, understand, and agree to be bound by the Terms and Conditions stated above, and I authorize America's Energy, Inc. to investigate credit history and contact all references provided.

Full Name (This will be your signature) *

Title *

Date *

Signature Preview

John Michael Doe

By typing your name above and submitting this form, you are signing this document electronically. You agree that your electronic signature is the legal equivalent of your manual signature. Your signature confirms that you have read and agree to all Terms and Conditions stated above, and authorize America's Energy, Inc. to investigate credit history and contact all references.

Personal Guarantee

Personal guarantee by business owner(s) or principal(s). This section is optional but may improve credit approval.

I want to provide a personal guarantee (recommended for faster approval)

PERSONAL GUARANTEE

FOR VALUE RECEIVED, the undersigned (individually and collectively "Guarantor") absolutely, unconditionally, and irrevocably guarantees to AMERICA'S ENERGY, INC. ("AEI") the full and prompt payment and performance of all debts, obligations, and liabilities of every kind and nature whatsoever which are now or may hereafter become owing by the above-named Buyer to AEI (collectively "Obligations").

1. CONTINUING GUARANTEE: This is a continuing guarantee and shall remain in full force and effect until written notice of revocation is delivered to AEI by certified mail. Revocation shall not affect Guarantor's liability for Obligations incurred prior to AEI's receipt of such notice.

2. UNCONDITIONAL OBLIGATION: The liability of Guarantor hereunder is unconditional and absolute and shall not be affected, modified, or impaired by:

Any modification, amendment, or extension of the credit terms between AEI and Buyer;
Any release, settlement, or compromise of any Obligation;
The insolvency, bankruptcy, or reorganization of Buyer;
The release of any other guarantor or the release of any collateral;
AEI's failure to give notice to Guarantor of any default by Buyer;
Any other circumstance that might otherwise constitute a legal or equitable discharge or defense of a guarantor.

3. WAIVERS: Guarantor waives: (a) notice of acceptance of this guarantee; (b) notice of the creation, modification, or acquisition of any Obligation; (c) presentment, demand for payment, protest, and notice of dishonor or default; (d) all rights to require AEI to proceed against Buyer or any other person or to pursue any other remedy; (e) any defense based on any claim that Guarantor's obligations exceed or are more burdensome than those of Buyer; and (f) the benefit of any statute of limitations.

4. IMMEDIATE PAYMENT: Upon default by Buyer, AEI may proceed immediately against Guarantor without first proceeding against Buyer or exhausting any other remedies. Guarantor agrees to pay AEI on demand all amounts due under the Obligations.

5. COSTS OF COLLECTION: Guarantor agrees to pay all costs and expenses, including reasonable attorney's fees and court costs, incurred by AEI in enforcing this guarantee or collecting any amounts due hereunder.

6. FINANCIAL INFORMATION: Guarantor agrees to provide AEI with current financial statements and other financial information upon request.

7. JOINT AND SEVERAL LIABILITY: If more than one person signs as Guarantor, each person's liability shall be joint and several, and AEI may proceed against any one or more Guarantors without affecting the liability of others.

8. SUCCESSORS AND ASSIGNS: This guarantee shall be binding upon Guarantor and Guarantor's heirs, executors, administrators, successors, and assigns, and shall inure to the benefit of AEI and its successors and assigns.

9. GOVERNING LAW: This guarantee shall be governed by the laws of the State of Arizona. Guarantor consents to the jurisdiction and venue of the state and federal courts located in Maricopa County, Arizona.

GUARANTOR ACKNOWLEDGES THAT GUARANTOR HAS READ THIS GUARANTEE, UNDERSTANDS ITS TERMS, AND AGREES TO BE BOUND BY IT. GUARANTOR FURTHER ACKNOWLEDGES THAT GUARANTOR IS PERSONALLY LIABLE FOR ALL OBLIGATIONS OF BUYER TO AEI.

Guarantor Information

Guarantor Full Legal Name (This will be your signature) *

Title / Position *

Date of Birth *

Home Address *

City *

State *

ZIP Code *

Guarantor Signature

Your typed name above will serve as your electronic signature.

Signature Preview

John Michael Doe

By typing your name and submitting this form, you are signing this guarantee electronically.

Date *

Spouse's Guarantee

Are you married?

Payment Method

Please select how you would like to pay for your orders.

How will you be paying? *

EFT (Electronic Funds Transfer)

AEI automatically withdraws funds from your bank account on invoice due date

ACH (Customer Initiated)

You initiate payment to AEI's bank account through your bank

Check

Pay by mailing a check to AEI

Credit Card

Pay by credit card (Note: 3% convenience fee applies)

ELECTRONIC FUNDS TRANSFER (EFT) AUTHORIZATION

I (We) hereby authorize AMERICA'S ENERGY, INC. ("AEI") to initiate debit entries to my (our) account indicated below and the financial institution named below ("Bank") to debit the same to such account.

AUTHORIZATION DETAILS:

Type of Payments: Payment for fuel, products, and services purchased from AEI
Frequency: As invoices become due according to agreed credit terms
Amount: Variable amounts as shown on invoices
Effective Date: Upon credit approval and account activation

TERMS AND CONDITIONS:

This authorization shall remain in full force and effect until AEI receives written notification from me (us) of its termination in such time and manner as to afford AEI and Bank a reasonable opportunity to act on it.
I (We) understand that AEI will provide advance notice of debit amounts and dates, typically via invoice or statement.
I (We) certify that I am (we are) authorized to execute this agreement and to initiate EFT transactions for the account designated below.
I (We) agree to hold AEI harmless from any loss, cost, or expense arising from any error in the processing of payments, provided AEI acts in good faith and in accordance with this authorization.
This authorization applies to the bank account specified below and shown on the voided check provided with this application.

NOTE: A voided check for the account indicated in Section 3 (Banking Information) must be provided to complete this authorization. The voided check will be used to verify routing and account numbers.

I authorize AEI to initiate EFT debits from my bank account for invoice payments *

EFT Bank Account Details

Please provide your bank routing and account number for EFT payments.

Routing Number * 9-digit ABA routing number (numbers only)

Account Number * Numbers only

EFT Contact Information

EFT Contact Name *

EFT Contact Email *

Bank Phone for EFT Verification

EFT Authorization Signature

By typing your name below, you authorize the electronic funds transfers as described above.

Full Name (This will be your signature) *

Date *

Signature Preview

John Michael Doe

By typing your name above and submitting this form, you are signing this EFT authorization electronically.

Upload Voided Check *

Please upload a clear image or scan of a voided check from the EFT bank account to verify your account information.

Click to upload or drag and drop PNG, JPG, or PDF (max 5MB)

Please select a payment method above to continue.

Review & Submit

Please review all information below before submitting your credit application.

Application Summary

Click "Edit" on any section to make changes.

Business Information

Ownership Information

Banking Information

Trade References

Terms & Conditions

Personal Guarantee

Payment Method

Additional Comments (Optional)

Final Certification

By submitting this application, you certify that all information provided is true, complete, and accurate to the best of your knowledge.

Submitting your information securely...

Account Setup

What products are you interested in purchasing?

How would you like to pay?

Save & Continue Later?

Account Setup

Business Information

Ship-To / Delivery Addresses

Ship-To Address #1

Ownership / Principal Information

Owner / Principal #1

Banking Information

Trade References

Trade Reference #1

Trade Reference #2

Trade Reference #3

Trade Reference #4 (Optional)

Terms & Conditions

Applicant Signature

Personal Guarantee

Guarantor Information

Guarantor Signature

Spouse's Guarantee

Spouse's Signature

Payment Method

EFT Bank Account Details

EFT Contact Information

EFT Authorization Signature

Upload Voided Check *

ACH / Wire Payment Information

Check Payment Information

Review & Submit

Application Summary

Business Information

Ownership Information

Banking Information

Trade References

Terms & Conditions

Personal Guarantee

Payment Method

Final Certification

COD / Autopay Account Setup

Business Information

Principal / Owner Information

Accounts Payable Contact

Entity & Tax Information

Arizona TPT Exemption Certificate (Form 5000A)

Delivery Information

Racing Fuel Declaration

Payment Method *

EFT Authorization

Credit Card Authorization

Agreements & Signature

Terms and Conditions

Payment Authorization

Racing Fuel Declaration (Arizona Form 96-3002)

Electronic Signature

Account Setup Submitted!