SuperPass™

Corporate Fuel Account

Application for a Petro-Canada SuperPass™ corporate credit account. Complete all required fields and submit — our accounts receivable team will follow up shortly.

Primary Supplier Location

Please check one site as your primary supplier.*

AthabascaBonnyville / Cold LakeFort McMurrayLac La Biche

Business Information

* If using AFFDA/Offroad number, account name applied for must read the same as legal name under tax-exempt #.

Business Name / Legal Operating Name in Full*

Street or Box #*

Town / City*

Province*

Postal Code*

Years in Business

Telephone*

Type of Business*

Email Address for Statements & Invoices*

Principals / Owners Information

Principal / Owner 1

Full Name*

Title*

Date of Birth*

S.I.N.*

Address*

Telephone*

Email*

Principal / Owner 2 (optional)

Full Name

Title

Date of Birth

S.I.N.

Address

Telephone

Accounts Payable Information

AP Contact Name*

Telephone*

Will a Purchase Order Number be Required?

YesNo

Address (if different from business address above)

Street or Box #

Town / City

Province

Postal Code

Financial Information

Bank #1 – Branch Name & Location*

Branch Contact Name*

Branch Phone*

Credit References

Please do not list banks or finance companies.

Company Name

Contact

Phone

Credit Agreement

I/We being principal(s) of the corporate customer acknowledge that I/we are co-customer(s)/co-purchasers and will be personally responsible jointly and severally with the corporate customer for any and all debt. I/We further agree to pay your account within your terms of payment net 30 days following purchase (INVOICE), to pay 2% interest and service charges per month (24% per annum) on overdue accounts and I/we assure full responsibility for any costs incurred toward collection of the account including legal fees. Signing this application consents to Cougar Fuels Ltd. obtaining from, exchanging with or disclosing to other credit grantors and recognized credit bureaus any and all information concerning the application for the purpose of ensuring the accuracy of this information, conducting ongoing credit investigations, monitoring credit status and entering into and performing the agreement. This information may be disclosed to Suncor Energy Product Partnership.

Principal 1 Full Name (typed signature)*

Principal 2 Full Name (if applicable)

Company / Business Name*

Dated at (City)*

Province

Day

Month

Year

Fuel Account & Card Requirements

Current Fuel Supplier*

Estimated Monthly Purchases ($)*

Credit Limit Required – 30 day terms ($)*

Please call me to customize my cards for location and product accessPlease add retail pump access

AFFDA #

Offroad # (A)

If numbers end in anything other than 01 or 06, number is expired.

PLEASE NOTE – above number MUST be under the same name as account name applied for.

Pre-Authorized Debit (PAD) Plan

I/we authorize Cougar Fuels Ltd., and the financial institution designated (or any other financial institution I/WE may authorize at any time) to begin deductions for payment of all charges arising under my/our Cougar Fuels Ltd. account(s). Regular monthly payments for the full amount of services delivered will be debited to my/our specified account on the 27th day of each month or the closest business day. This authority is to remain in effect until Cougar Fuels Ltd. has received written notification from me/us of its change or termination. This notification must be received at least ten (10) business days before the next debit is scheduled. For more information on my/our recourse rights, I/we may contact my/our financial institution or visit www.cdnpay.ca.

Name(s) on Account*

Date*

Address*

City / Town*

Province*

Postal Code*

Phone Number*

Authorized Signature – Type Full Name*

By typing your name above you authorize Cougar Fuels Ltd. to debit your account as described.

Please attach a VOID cheque or Bank Information Form

Void Cheque / Bank Information Form *

Fields marked with * are required. Your application will be sent to our accounts receivable team.

Cougar Fuels Ltd. — Accounts Receivable Department
5602 – 54 Avenue, Bonnyville, AB T9N 2N3 · (780) 826-3043