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Account Application
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Services
Products
Community
About Us
- Careers
- FAQ
- New Look
Contact Us
Account Application
Payment Portal

Account Application

Click here to download printable application

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All information provided on this form is secured. All sensitive information is protected and not shared with any third party.

Applicant Type
Application For:*
- A Business
- Individual Applicant
Business Information
Company Name*
DBA or Trade Name
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Billing Phone
Company URL
Delivery Location Name*
Is billing address the same as the delivery address?
- Yes
- No
Delivery Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Secondary Delivery
Delivery Location Name
Delivery Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Company Type
- Corporation
- LLC
- Sole Proprietorship
- Partnership
If Incorporated, State of Corporation
Date of Corporation
Federal ID*
UBI
Years Established
Accounts Payable Contact
(emailed invoices/statements)
Phone*
Email*
Tax Information
Reseller's Permit Number
Do you have other tax exemptions?
- Yes
- No
If yes, please upload copies of all tax exemptions. Taxes will be charged on all invoices until exemptions are received.
Upload File
Principal Owners/Individual Information
Name*
First Last
Title
% Ownership
Phone*
Email*
Date of Birth*
Date Format: MM slash DD slash YYYY
SSN*
Driver's License Number*
Billing Address*
Street Address Address Line 2 City State ZIP Code
Is the delivery address the same as the billing address?
- Yes
- No
Delivery Address
Street Address Address Line 2 City State ZIP Code
Employer
Spouse's Name
Spouse's Employer
Secondary
Name
First Last
Title
% Ownership
Phone
Employer
Spouse's Name
Spouse's Employer
Any applicant ever filed for bankruptcy?*
- Yes
- No
Bank Information (Business Applicants)
Bank Name*
Bank Representative
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Checking Account Number*
Products/Services You Are Applying For
Do you need Cardlock?
- Yes
- No
Products
Product name Quantity

Bulk Fuel Lubricants Marine Fuel DEF
Product Name/Tank Sizes for Bulk Products
Current Fuel/Lubricants Provider

Credit Agreements and Terms
Consent*
I agree to the privacy policy.
By signing below, I am authorized, and asking Wilson Oil Inc., dba Wilcox + Flegel (hereafter referred to as “Wilcox + Flegel” or “Seller”) to open an account in the
name of the Primary Applicant listed under “Name” in the Business Information section of this application form (hereafter referred to as “Customer”). Customer
authorizes Seller to obtain personal (Consumer or Business) credit report(s) and to make whatever inquiries deemed necessary to establish credit worthiness, including Customer’s Bank(s) or Financial Institutions as listed in this application or credit reports. Customer agrees to pay finance charges at the rate of 1.5 % monthly (18% APR) of total amount (after applying all payments and/or credits) remaining unpaid for 30 days or more. Customer agrees to pay any and all expenses incurred by Seller (including fees for legal costs and collection agency fees of every kind) to collect, defend, or assert the right of Seller, to obtain the payment of expenses and indebtedness relating to this account. Customer agrees to pay 2.25% surcharge on any balances paid with a credit card.
It is mutually understood and agreed that this contract shall be governed by the laws of the State of Washington, both as to interpretation and performance. The courts of the State of Washington shall have jurisdiction over all parties to this agreement and any action regarding this agreement shall be instituted only in the courts of the Cowlitz, Clark, or King County, Washington, at Seller’s discretion. Customer agrees to notify Seller at least 30 days prior to any ownership change or transfer, or any significant changes or transfer of assets, or if no notice is given, all assets of Customer shall have a lien by Seller, including those sold. Time is of the Essence of this agreement. Customer certifies that all information on this application is correct and that Customer fully understand Seller’s credit terms in consideration of credit extended.
Seller reserves the right to change the terms of sale and credit on this account at any time, with or without notice to Customer and at our sole and absolute discretions.
Customer grants to Seller a Purchase Money Security Interest (PMSI) in all petroleum product and synthetic lubricant inventory, and its proceeds and receivables, all
Seller purchased/furnished equipment, and all rights of said collateral no matter where located.
Facsimile or electronic signatures will be deemed to constitute and be an original signature of the Customer. The undersigned individual represents that he/she is
authorized to enter into this Agreement on Customer’s behalf.
Name (Printed)*
First Last
Applicant Signature*
Date*

Electronic Funds Transfer (EFT) Authorization
EFT authorization is not required but highly recommended for ease of payment.
I/we hereby authorize Wilson Oil, Inc., dba Wilcox and Flegel to initiate debit and credit entries to the account listed below. This account is used solely for business purposes for payment of all obligations determined by Wilson Oil, Inc., to be owing as a customer of Wilson Oil, Inc., and all obligations determined by Wilson Oil, Inc., to me as a customer.
Bank Name
Bank Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Bank Contact
First Last
Bank Contact Phone
Bank Contact Email
Account Number
Routing Number
I/we further certify that Wilson Oil, Inc., dba Wilcox and Flegel is authorized to notify the bank named above to accept such debit and credit entries from Wilson Oil Inc. This authority shall remain in full force and effect until ten (10) days after Wilson Oil, Inc. and the Bank have received written notification from me/us of its termination. I/we understand that this EFT/ACH service is governed by the rules of The Automated Clearing House and that Wilson Oil, Inc., can terminate or modify at any time.
Name (Printed)
First Last
Date
Secondary
Name (Printed)
First Last
Date

Cardlock
Regardless of which state you are a resident of, dispensing gasoline from any Oregon cardlock facility for non-business use is prohibited by law. The State of Oregon can penalize you up to $500 and one year in jail for dispensing gasoline without authorization. Please reference the Oregon State Fire Marshall (OSFM) Explanation of Eligibility for more information.
Oregon PUC Diesel
- Yes
- No
Do you have additional exemptions?
- Yes
- No
If yes, please attach copies of all exemptions. Taxes will be changed on all invoices until exemptions are received.
Upload Attachment if Yes
Do you meet the requirements to purchase gasoline in Oregon?
- Yes
- No
If yes, please fill out OR Cardlock Customer Agreement and provide proof of business.
Do you meet the requirements to purchase off-road diesel in Oregon?
- Yes
- No
If yes, please fill out OR Off-Road Diesel Form.
Card Order Form
Vehicle Description/Unit Number
Driver Name
First Last
5 Digit Driver ID Security Code
Select all that apply:
- CFN
- Pacific Pride
- Gas
- Diesel
- Off-road Diesel
Vehicle Description/Unit Number
Driver Name
First Last
5 Digit Driver ID Security Code
Select all that apply:
- CFN
- Pacific Pride
- Gas
- Diesel
- Off-road Diesel
Vehicle Description/Unit Number
Driver Name
First Last
5 Digit Driver ID Security Code
Select all that apply:
- CFN
- Pacific Pride
- Gas
- Diesel
- Off-road Diesel
Vehicle Description/Unit Number
Driver Name
First Last
5 Digit Driver ID Security Code
Select all that apply:
- CFN
- Pacific Pride
- Gas
- Diesel
- Off-road Diesel
Vehicle Description/Unit Number
Driver Name
First Last
5 Digit Driver ID Security Code
Select all that apply:
- CFN
- Pacific Pride
- Gas
- Diesel
- Off-road Diesel
Vehicle Description/Unit Number
Driver Name
First Last
5 Digit Driver ID Security Code
Select all that apply:
- CFN
- Pacific Pride
- Gas
- Diesel
- Off-road Diesel
Cardlock Agreement and Terms
Consent*
I agree to the privacy policy.
1. This access card is used to initiate Pacific Pride/CFN transactions. This access card is not a credit card.

2. Customer shall be responsible for payment to Wilson Oil, Inc., dba Wilcox + Flegel (hereafter referred to as “Wilcox + Flegel) for all purchases made using the cardlock cards assigned to the Customer by Wilcox + Flegel. Customer assumes all liability arising from the use, misuse, unauthorized use, loss or theft of any one or more of the fuel access cards. If customer knows of or suspects the loss, theft, or possible unauthorized use of a card or account or if Customer would like to terminate a fuel access card, the customer must immediately notify Wilcox + Flegel by calling (800) 438-9656. Customer must also follow up with written notice, including card number(s) to be disabled, to Wilcox and Flegel by emailing [email protected] Customer remains responsible for all charges, including unauthorized charges until written notice is received.

3. The purchaser agrees that they, or anyone issued cards under them, will not have the Driver ID security access code on or near the card(s). Customer will safeguard the Driver ID security access code from all unauthorized users. This includes protecting the fuel access cards from devices that may skim or replicate the cards in some way. Customer will be responsible for all transactions initiated with a skimmed or replicated fuel access card assigned to Customer. For more information on how Wilcox + Flegel can help keep you protected please email [email protected]

4. Customer represents that they, and any person using the cardlock, will first receive Oregon Fire Safety Training to make each user fully understand proper use of the cardlock system and shall use safe practices in compliance with the regulations of the local Fire Code in the handling of the fuels dispensed from the cardlock system. Customer agrees to indemnify and hold Wilcox + Flegel harmless from any claims and costs including, but not limited to, those for bodily injury and property damage which may be occasioned by the negligence or misuse of the cardlock system by Customer or any other person using the cardlock cards assigned to the Customer hereunder.

5. Fuel prices are subject to change at any time and without notice. Fuel purchased from the cardlock system will include applicable fuel taxes unless Customer is exempt from tax pursuant to state and federal laws. Exemption from state taxes will only be granted upon proof of exemption as required by Wilcox + Flegel. Customer retains full responsibility for tax payments should a taxable use arise, including cancellation or expiration of exemption permits.

6. Wilcox + Flegel does not monitor customer transactions. Customer will review all invoices provided by Wilcox + Flegel and will notify Wilcox + Flegel no later than 15 calendar days after the date of each invoice of any errors with respect to the invoices to be eligible for review. After 15 calendar days, each such invoice and the transaction therein will be binding on Customer.

7. Wilcox + Flegel shall use its best efforts to maintain the cardlock system in good working order and condition, at its expense, provided however Wilcox + Flegel, shall not be responsible for any damage or loss which may result from its failure to provide fuel or the failure of the cardlock system in any manner whatsoever. Customer agrees that it and any other person using the cardlock card(s) assigned to the customer shall properly notify Wilcox + Flegel, of any malfunctioning of the cardlock system of which Customer or such person is aware.

8. Cardlock accounts are billed as of the 15th and the last day of the month and payment is due upon receipt of invoice. Nonpayment of current charges by the consecutive billing date will constitute as a default on the agreement and credit privileges may be terminated until payment is received or when Wilcox + Flegel deems appropriate.

9. Customers right to purchase fuel through the cardlock system may be terminated immediately upon any breach of any of the terms hereof or of any other agreement with Wilcox + Flegel. Upon termination, Customer agrees to surrender all cardlock cards issued to Customer and to immediately pay all outstanding sums owing. Cardlock agreement and terms are subject to change at any time, with or without notice to customer and at our sole and absolute discretion.

10. Facsimile or electronic signatures will be deemed to constitute and be an original signature of the party. The undersigned individual represents that he/she is authorized to enter into this Agreement on Customer’s behalf.
Name (Printed)*
First Last
Applicant Signature*
Date*
Name (Printed)
First Last
Applicant Signature
Date
Date Format: MM slash DD slash YYYY

Personal Guarantee
Consent*
I agree to the privacy policy.
By signing below, I am authorized, and asking Wilson Oil Inc., dba Wilcox + Flegel (hereafter referred to as “Wilcox + Flegel” or “Seller”) to open an account in the
name of the Primary Applicant listed under “Name” in the Business Information section of this application form (hereafter referred to as “Customer”). Customer
authorizes Seller to obtain personal (Consumer or Business) credit report(s) and to make whatever inquiries deemed necessary to establish credit worthiness, including Customer’s Bank(s) or Financial Institutions as listed in this application or credit reports. Customer agrees to pay finance charges at the rate of 1.5 % monthly (18% APR) of total amount (after applying all payments and/or credits) remaining unpaid for 30 days or more. Customer agrees to pay any and all expenses incurred by Seller (including fees for legal costs and collection agency fees of every kind) to collect, defend, or assert the right of Seller, to obtain the payment of expenses and indebtedness relating to this account. Customer agrees to pay 2.25% surcharge on any balances paid with a credit card.
It is mutually understood and agreed that this contract shall be governed by the laws of the State of Washington, both as to interpretation and performance. The courts of the State of Washington shall have jurisdiction over all parties to this agreement and any action regarding this agreement shall be instituted only in the courts of the Cowlitz, Clark, or King County, Washington, at Seller’s discretion. Customer agrees to notify Seller at least 30 days prior to any ownership change or transfer, or any significant changes or transfer of assets, or if no notice is given, all assets of Customer shall have a lien by Seller, including those sold. Time is of the Essence of this agreement. Customer certifies that all information on this application is correct and that Customer fully understand Seller’s credit terms in consideration of credit extended.
Seller reserves the right to change the terms of sale and credit on this account at any time, with or without notice to Customer and at our sole and absolute discretions.
Customer grants to Seller a Purchase Money Security Interest (PMSI) in all petroleum product and synthetic lubricant inventory, and its proceeds and receivables, all
Seller purchased/furnished equipment, and all rights of said collateral no matter where located.
Facsimile or electronic signatures will be deemed to constitute and be an original signature of the Customer. The undersigned individual represents that he/she is
authorized to enter into this Agreement on Customer’s behalf.
Name (Printed)
First Last
Applicant Signature
Date
Date Format: MM slash DD slash YYYY
Secondary
Name (Printed)
First Last
Applicant Signature
Date
Date Format: MM slash DD slash YYYY
Application Submission
Consent*
I agree to the privacy policy.
I certify the information captured in this application is accurate and complete to the best of my knowledge.
Name (Printed)*
First Last
Applicant Signature*
Date*
Comments
This field is for validation purposes and should be left unchanged.

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Your power is our priority.

Whether on the road or in the office, we're in it for the long haul.

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95 Panel Way Longview, WA 98632

(800) 438-9656

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