Contact Info

First_Name Last_Name

Phone

Business Info

DBA

Address

City,State

Zip_Code

Application Decision

Disclosure

Card Setup

Trouble with the form? 1-800-383-5626

Let's start with your contact info

Please tell us who you are and how to contact you so that we can stay in touch regarding your application

First Name

Last Name

Business ZIP Code

Business Name

Email Address

Your Email Address is needed to contact you regarding the status of your application. We will not share your information with any third parties. See our Privacy Policy for more information.

Phone Type

Phone Number

How many vehicles are in your fleet?

I am an Authorized Officer of the Business

You must be an Authorized Officer with significant management responsibility, such as President, CEO, CFO, Treasurer, and will be required to certify to complete and correct information for this application. If applicable, your valid Social Security Number and other personal information, as well as that of the Business owners, is required to comply with Federal regulations to help fight crime.

Stay connected! Opt in to receive texts with updates and alerts about your application and product usage, plus additional offers. By opting in, you agree to our Messaging Service Terms & Conditions.

Hello First_Name, Nice to meet you!

Please review the information below and edit if necessary. When everything is correct, select Continue to go to the next step.

DBA

Business Address
Address
City, State, Zip_Code

Business Phone Number
Phone_Account_Business_Number

Federal ID Number
Federal_ID_Number

Subsidiary or Doing Business As

Federal ID Number

Business Address

Business Address 2

State

City

Zip Code

Business Phone Number

Use business address as billing address?

Billing Address

Billing Address 2

Billing State

Billing City

Billing Zip Code

Type of Business

How many drivers do you have?

Estimated Monthly Fuel Spend

Statement Delivery Method

Billing Email Address

Years in Business

Annual Business Revenue

The application is almost complete!

You are just one step away from your card.

Owner of the Business

Same as Contact info

First Name

Last Name

Date of Birth (MM/DD/YYYY)

Social Security Number

Your personal information will not be used to make a credit decision.
To help fight financial crime, Federal regulation requires financial institutions to collect, verify, and maintain information about the beneficial owners of legal entity customers. This information helps law enforcement confirm legal ownership and investigate and prosecute financial crimes (such as terrorist financing and money laundering).

Street Address

Street Address 2

City

State

Zip Code

A valid email address is required for ownership certification and/or personal guarantee documents. We will not share your information with any third parties. See our Privacy Policy for more information.

Mobile Phone Number

Secondary Phone Number

This person owns 100% of the company

First Owner Ownership Percentage

Second Owner of the Business

Same as Contact info

Second Owner Ownership Percentage

First Name

Last Name

Date of Birth (MM/DD/YYYY)

Social Security Number

Street Address

Street Address 2

City

State

Zip Code

Mobile Phone Number

Secondary Phone Number

Third Owner of the Business

Same as Contact info

Third Owner Ownership Percentage

First Name

Last Name

Date of Birth (MM/DD/YYYY)

Social Security Number

Street Address

Street Address 2

City

State

Zip Code

Mobile Phone Number

Secondary Phone Number

Fourth Owner of the Business

Same as Contact info

Fourth Owner Ownership Percentage

First Name

Last Name

Date of Birth (MM/DD/YYYY)

Social Security Number

Street Address

Street Address 2

City

State

Zip Code

Mobile Phone Number

Secondary Phone Number

All the people, who own 25% or more of the company are specified

Personal Guarantor

This is the same person as the Contact Info

First Name

Last Name

Date of Birth (MM/DD/YYYY)

Social Security Number

PG Social security number

Street Address

Street Address 2

State

City

Zip Code

Mobile Phone Number

Secondary Phone Number

Significant Manager

First Name

Last Name

Date of Birth (MM/DD/YYYY)

Social Security Number

Street Address

Street Address 2 (Suite#, Ste#, Unit#, Apt#)

State

City

Zip Code

Phone Number

Secondary Phone Number

As part of our commitment to transparency, please certify your agreement to each fee for this product. Please refer to the Product Client Agreement for details:

Product Fee Description

I agree to the credit application terms: Application Terms & Conditions *

I authorize you to obtain my personal credit report. I consent/agree to the personal guarantee and to be legally bound to the terms and conditions of the personal guarantee *

By pressing "Process my Application", I agree to the Product Client Agreement, including fees, shown above. I also confirm that I have provided complete and correct information in the application.

Application Terms & Conditions

the content in this section will be replaced with the T&C html from the PIM

Congratulations, First_Name!

You're approved for the Fuelman Diesel Basic Card with $GDS_CL credit limit and monthly payments.

Please wait while we transfer you to your cards configuration page...

Applicable law requires this information be provided to you to help you make an informed decision. By checking this box, you are providing your electronic signature and confirming that you received this information.

Your cards are set and ready to go out!

Based on your application, we've setup up Number_Of_Vehicles cards, using default information. Please choose your statement delivery method, verify your card information, and then select Complete My Application to finish.

N Digit Security passcode

Create a N-digit passcode for accessing your account. You’ll be asked for this PIN code when dialing our Service hotline.

Driver cards are assigned to individual drivers. When fueling a vehicle, the driver must enter a unique PIN associated with the vehicle.

Prefer to use driver cards
instead of vehicle cards?

Switch to Driver Cards >

Vehicle Cards

Add card description then select purchase type.

Description *

Purchase Type *

Driver Prompts *

Vehicle Type *

Card Description

Purchase Type *

Driver Prompts *

Vehicle Type

Cards Users

Add your driver's names or adjust the card PINs.

First Name *

Last Name *

Pin Code *

First Name

Last Name

You are about to delete card user

Note that this card user will removed from all associated vehicle cards. Click the delete button to confirm the removal of card user.

You are about to delete vehicle pin

Note that this vehicle pin will removed from all associated driver cards. Click the delete button to confirm the removal of vehicle pin.

You are about to delete vehicle card

Note that this vehicle card will be removed from all associated card users. Click the delete button to confirm the removal of vehicle card.

You are about to delete driver card

Note that this driver card will be removed from all associated vehicle pins. Click the delete button to confirm the removal of driver card.

Are you still there?

To protect your privacy, this session will time out in 02:00 minutes. If the session expires, you will need to start over.

Your cards are set and ready to go out!

N Digit Security passcode

Create a N-digit passcode for accessing your account. You’ll be asked for this PIN code when dialing our Service hotline.

Vehicle cards are assigned to specific vehicles. The driver must enter their personal driver PIN when using these cards for fueling.

Prefer to use vehicle cards
instead of driver cards?

Switch to Vehicle Cards >

Driver Cards

Add your driver's names then select purchase type.

Full Name *

Purchase Type *

Driver Prompts *

Vehicle Type *

Full Name

Vehicle Type

Vehicle Pins

Add your vehicle's names or adjust the card PINs.

Description *

Pin Code *

Description

Oops! It’s not you it’s us.

The application process seems to be having technical difficulties. A member of our new accounts team will contact you shortly to help you complete and submit your application.

We appreciate your patience

Application is already submitted.

Your application is already submitted! If you have any questions, please contact our team at 1-800-877-0800.

Sorry something went wrong.

It’s not you, it’s us. It seems like something went wrong with your application. If you continue to experience issues, please contact our team at 1-800-877-0800.

We appreciate your patience

You've reached the maximum allowed attempts to provide valid funding information for this application. To continue, please contact our support team at 1-800-877-0800 for assistance.

Thank you for your application, First_Name!

But we are unable to approve you at this time.

Thank you for your application.

Your application is already submitted! If you have any questions, please contact our team at 1-800-877-0800.

All done, First_Name.

Your cards are on the way!

Thank you, First_Name. Your application and card setup are complete. Your cards will arrive in 7 -10 business days. If you have any questions, please contact Account Management at 1-800-877-0800.

CARDS ORDERED

mm/dd/yyyy

All done, First_Name.

Your cards are on the way!

Thank you, First_Name. Your application and card setup are complete. We'll contact you personally within the next business day to review the details of your application. If you have any questions, please contact Account Management at 1-800-877-0800.

CARDS ORDERED

mm/dd/yyyy

Thank you for your application, First_Name!

We're processing your request and will have a member of our new accounts team contact you personally to complete your application.

Thank you for your application, First_Name!

We're not able to provide you with a decision at this time, but will contact you within the next 30 days with more information. If you have any questions, please contact Account Management at 1-800-877-0800.

Thank you for your application, First_Name!

We are unable to process your request because you have another application already in the system. If you have any questions, please contact Account Management at 1-800-877-0800.

Congratulations, First_Name!

Your Credit Application is Conditionally Approved! Great news!

We've conditionally approved your credit application. To continue, we require a personal guarantee from you, ensuring all account obligations are met, which will include necessary creditworthiness verification as a final step.

First Name

Last Name

Date of Birth (MM/DD/YYYY)

Social Security Number

PG Social security number

Street Address

Street Address 2

State

City

Zip Code

Mobile Phone Number

Secondary Phone Number

I authorize you to obtain my personal credit report. I consent/agree to the personal guarantee and to be legally bound to the terms and conditions of the personal guarantee *

Verify your identity

To verify your identity please enter your email address and phone number used in the application.

How Do I Know My Data is Secure?

Your data is handled using 256-bit encryption. Rest assured that we never store any of your credentials.

Email Address

Phone Number

Verifying credentials

Please wait while we verify your credentials...

Credentials do not match

The authenticated credentials do not match as expected. Please verify the credentials and proceed with the authentication process.

Authentication locked

The authentication process is locked due to multiple failed attempts.

Congratulations, First_Name!

Based on the information you submitted you're pre-approved for Fuelman Diesel Basic

Your next step is to help us confirm your identity.

Verify your phone number

We need to send you a verification code to verify that you are the account owner. For account safety, you cannot use new contact information

Send verification code via:

Text Me: OTP_Verified_Phone

Call Me: OTP_Verified_Phone

Please enter the code we've sent to OTP_Verified_Phone

This code will expire in 10 minutes

Sorry, the verification code you entered is incorrect.

Enter the verification code:

Didn't get the code? Request another one

Request another one in N seconds

Congratulations, First_Name!

Based on the information you submitted you're pre-approved for Fuelman Diesel Basic

To complete your account set up we must verify your identity.

Verify your identity

This verification will be conducted by 3rd party partners and should take no more than 5-10 minutes of your time.

Buckle up, you are on your way to Smartest Fuel Card!! Use your webcam or phone to photograph:

your identity document
your face

By clicking on the 'Accept' Button or otherwise continuing to use this service you agree you have read, understand and accept Onfido Facial Scan Policy, Privacy Policy and Terms of Service.

Last Step: Verification

Before we can process your application, we'll need you to verify the business identity and your authority to perform financial transactions on behalf of the business. To complete verification, please log in to the company's bank account (or to your personal account, if you are the owner) from this page and grant us access to view it.

NOTE: This process is encrypted for your security. We do not have access to any login credentials, nor do we share any of your banking information. You are not linking or connecting your account in any way.

I agree to share my bank credentials with Plaid (Preferred)

The name and the address on the business bank account should match to this application

No, I want to upload my bank statement instead

Minimum 3 months of business banking statements

To qualify for this offer, a minimum average daily balance of $5000 is required.

Upload Bank Statement

Please review the information below and edit if necessary. When everything is correct, select Continue to go to the next step.

Instructions: A minimum of 3 months of bank statements is needed.
You can use 1 Adobe pdf file or separate pdf files. Maximum of 6 files can be added below. Please make sure the document you are uploading is not password protected.

Upload Statements

File Size Limit: 2MB

or drop file here

Supported formats

Adobe PDF files

File Name

Type

File Size

filename.pdf

pdf

00.00 KB

To begin, please select one of the following:

I can confirm that I am sharing my business bank account details. (Preferred)

Name and address of the business must match those on this application.

I confirm that I am sharing my personal bank account details.

Name and address on the account must match those of the Personal Guarantor identified in this application.

I can confirm that I am sharing my business bank account details.

The name and the address on the business bank account should match to this application

I agree to Plaid Terms of Service *

I agree to Plaid Privacy Policy *

Upload Error

The file size exceeds the allowable limit of 2MB

File name already exists. Please change the file name or upload another file.

Maximum of 6 files can be uploaded.

Please wait, we are processing your bank account information

This may take between 1-2 minutes to complete.

Verify your bank account

Please select the bank account you'd like to use to verify your account.

Processing your application

Please wait while we process your application. This may take between 1-2 minutes to complete.

Congratulations, First_Name!

Based on the information you submitted, you're pre-approved for:

Fuelman Diesel Basic with daily autopay.

Receive an additional 2¢ off per gallon by securely connecting your account now.¹

¹2¢ rebate is in addition to your initial per gallon rebate offer. Both the 2¢ and your initial per gallon rebates are subject to change beginning 12 months after account setup. To receive rebates, your account must not be in default of payment terms.

Connect your bank account

Congratulations, First_Name You're approved!

You're approved for the Fuelman Diesel Basic Card with a $GDS_CL credit limit and daily payments.

Please wait while we transfer you to your cards configuration page...

Thank you for your application, First_Name!

But we are unable to approve you at this time.

You have reached the maximum allowed attempts to provide valid banking information for this application. Our representative will contact you shortly to provide further instructions on how to complete the application successfully. Thank you for your patience and cooperation.

Safe & Secure

CORPAY considers your privacy important. We are committed to protecting the privacy of those who provide us with their contact and personal information. For more info see our Privacy Policy & Terms of Use