Phillips Aviation 66 | phillips66.wfscorp.com

Company Information

Company Name *

Street Address 1 *

Street Address 2

City *

State, Zip / Postal Code & Country *

Phone Number

Fax Number

Parent Company Information

Principal / Parent Company *

Address *

Company Registration Number

Phone Number

Primary Business

Number of Employees

Website

Billing Address

Billing Address - Same as Company

Company Name *

Street Address 1 *

Street Address 2

City *

State, Zip / Postal Code & Country *

Phone Number

Fax Number

Contact Details - Primary

Name *

Position

Phone *

Cellular

Fax

Email *

Contact Details - Accounting

Name *

Position *

Phone *

Cellular

Fax

Email *

Contact Details - Chief Pilot

Name *

Position *

Phone *

Cellular

Fax

Email *

Financial Information

Website

Country of Incorporation *

Years in Business

Annual Revenue (USD) *

Number of Employees

Company Registration Number

Stock Ticker

Federal ID Number

VAT / IVA / TVA Number

Type of Company *

Proprietorship

Partnership

Corporation

Government

Bank and Trade References

Bank Reference 1 *

Bank Name, Account Number, Address and Contact Information.

Bank Reference 2

Bank Name, Account Number, Address and Contact Information.

Trade Reference 1 *

Company Name, Address and Contact Information (Please don't reference other charge cards).

Trade Reference 2

Company Name, Address and Contact Information (Please don't reference other charge cards).

Credit Request

Fleet Information

Aircraft 1

Tail Number *

Type of Aircraft *

Make and Model

Owned or Leased *

Owned

Leased

Home Base Airport *

IATA/ICAO

Expected Monthly Fuel Consumption *

Special Handling Requirements *

Aircraft 2

Tail Number

Type of Aircraft

Make and Model

Owned or Leased

Owned

Leased

Home Base Airport

IATA/ICAO

Expected Monthly Fuel Consumption

Special Handling Requirements

Aircraft 3

Tail Number

Type of Aircraft

Make and Model

Owned or Leased

Owned

Leased

Home Base Airport

IATA/ICAO

Expected Monthly Fuel Consumption

Special Handling Requirements

Product Request

Phillips 66 Aviation Wings Card *

Yes

No. of Cards per Aircraft *

Web Access Information

Email Address

Phone / Fax

Contact Name

Username

Require Access to

Invoice and Reporting

Additional Information

Typical Destinations Served

Key Suppliers

Seasonal or Non-Seasonal

Seasonal

Non-Seasonal

Major Partners / Customers / Managed Customers

Comments / Additional Information

Referral

Individual Name of Referral:

ICAO

Referring FBO Name:

Signature

Title

Date

Contact Phone

Financial Statements

Please submit your most recent interim Balance Sheet and Income Statement and your most recent fiscal year-end Balance Sheet and Income Statement. All

financial statements must be signed and dated by an officer, owner or partner. If certified, audited or reviewed statements are available, they are preferred. A

personal guarantee may be required. Financial statements and other Company financial information provided to World Fuel Services, Inc. will be treated as

confidential information.

I. SIGNATURE APPROVAL AND ACCEPTANCE OF TERMS AND CONDITIONS:

1. The Company warrants that the preceding information is true, correct and complete and agrees to inform World Fuel Services, Inc. in a timely manner of any

ownership changes and/or material adverse changes to the Company’s financial position.

2. The Company authorizes (a) the references listed in this application to release to World Fuel Services, Inc. information related to the Company’s accounts and

(b) World Fuel Services, Inc. to secure information regarding the Company’s credit history from any commercial or consumer reporting agency or trade

organization.

3. The Company agrees that all AVCARD transactions and Customer’s use of the AVCARD are subject to the Terms and Conditions for Aircraft Operators Use

of the AVCARD Charge Card found at https://www.wfscorp.com/Aviation/Business_Aviation/pdf/wfs-ba-avcard-tc.pdf

4. If the customer is an LLC the signatory warrants he/she is a managing member.

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