Legal Name of Purchaser:
Trading Name (DBA):
Phone:
Fax:
Email:
Website:
Registered Office Address:
Country:
State:
City:
Zip Code:
P.O.Box:
Nature of Operations: AirlineCharterPrivateMaritimeLand FuelOther
Applicant is a: CorporationPartnershipLLCOther
FEIN #:
Co. Established Year:
Inc. in State/Country:
VAT #
DUNS #:
Parent Company Name:
Federal Tax Exempt: YesNo
VAT Exempt: YesNo
**Please provide copies of all licenses, AOCs and Certificates to benefit fully from any tax exemption eligibility**
Owner/Officer:
Title:
Physical Address:
State/Province:
Operations Contact:
Email Address(es) for Fuel Authorizations:
Pricing Contacts and Formats:
Email Address(es) for Price Notices:
Please select format(s) you would like to receive your price notices in: .pdf.xlsl.csv
Accounts Payable Contact:
Email Address(es) for Invoice Delivery:
Bank name:
Bank Address:
Account No.:
Account Name:
SWIFT:
IBAN:
Requested Payment Terms (days):
Requested Credit Amount USD:
1. Company Name:
Contact Name:
Company Address:
2. Company Name:
Please provide aircraft tail number(s) and type
Tail#:
Type:
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Customer acknowledges that AEG fully complies with the laws and regulations enforced by the U.S. Treasury Department’s Office of Foreign Assets Control (OFAC).
Customer acknowledges that neither Customer nor any aircraft it operates is owned in whole or part by a Specially Designated National (SDN).
Customer agrees that it will not allow any SDNs to travel as passengers on Customer’s aircraft.
Customer agrees that it will not order fuel for any flight with a destination of Iran, North Korea, Syria or Crimea.
AEG FUELS Sales Executive Contact:
All sales are subject to AEG's General Terms and Conditions. I have read and accept AEG’s General Terms and Conditions
Signature (please use your mouse to sign)
Date:
Print Name:
Title
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