Comdata Connect Card

OWNER CONTACT INFORMATION

Let's start with your contact info

I am an Owner of the Business

First Name

Last Name

Phone Number

Email Address

Business ZIP Code

Business Name

How many vehicles are in your fleet?

I am an Authorized Officer of the Business

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Owner First Name

Owner Last Name

Owner Phone Number

Owner Email Address

DOT Number

Owner Business Name

How many vehicles are in your fleet?

Owner First Name

Owner Last Name

Owner Phone Number

Owner Email Address

DOT Number

Owner Business Name

How many vehicles are in your fleet?

BUSINESS INFORMATION

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.

Motor Carrier or DOT Number

Subsidiary or Doing Business As

How many drivers do you have?

Number of cards requested

Federal ID Number

Business Phone Number

Business Address

Business Address 2

City

Zip Code

Use business address as billing address?

Billing Address

Billing Address 2

Billing City

Billing Zip Code

Federal ID Number

Business Phone Number

Business Address

Business Address 2

City

Zip Code

Federal ID Number

Business Phone Number

Business Address

Business Address 2

City

Zip Code

BUSINESS OWNER INFORMATION

Tell us more about the owner of Company_Name

You are one step away from your card

Same as Contact info

First Name

Last Name

Phone Number

Email Address

Date of Birth (MM/DD/YYYY)

Social Security Number

Address

Address 2

City

Zip Code

This person owns 100% of the company

Second Owner Information

First Name

Last Name

Phone Number

Email Address

Date of Birth (MM/DD/YYYY)

Social Security Number

Address

Address 2

City

Zip Code

Second Owner Ownership Percentage

Add Additional Owner

Remove

Third Owner Information

First Name

Last Name

Phone Number

Email Address

Date of Birth (MM/DD/YYYY)

Social Security Number

Address

Address 2

City

Zip Code

Third Owner Ownership Percentage

Add Additional Owner

Remove

Fourth Owner Information

First Name

Last Name

Phone Number

Email Address

Date of Birth (MM/DD/YYYY)

Social Security Number

Address

Address 2

City

Zip Code

Fourth Owner Ownership Percentage

Remove

Owner Social Security Number

Owner Address

Owner Address 2

Owner City

Owner Zip Code

This person owns 100% of the company

Second Owner Information

First Name

Last Name

Phone Number

Email Address

Date of Birth (MM/DD/YYYY)

Social Security Number

Address

Address 2

City

Zip Code

Second Owner Ownership Percentage

Add Additional Owner

Remove

Third Owner Information

First Name

Last Name

Phone Number

Email Address

Date of Birth (MM/DD/YYYY)

Social Security Number

Address

Address 2

City

Zip Code

Third Owner Ownership Percentage

Add Additional Owner

Remove

Fourth Owner Information

First Name

Last Name

Phone Number

Email Address

Date of Birth (MM/DD/YYYY)

Social Security Number

Address

Address 2

City

Zip Code

Fourth Owner Ownership Percentage

Remove

Owner Social Security Number

Owner Address

Owner Address 2

Owner City

Owner Zip Code

This person owns 100% of the company

Second Owner Information

First Name

Last Name

Phone Number

Email Address

Date of Birth (MM/DD/YYYY)

Social Security Number

Address

Address 2

City

Zip Code

Second Owner Ownership Percentage

Add Additional Owner

Remove

Third Owner Information

First Name

Last Name

Phone Number

Email Address

Date of Birth (MM/DD/YYYY)

Social Security Number

Address

Address 2

City

Zip Code

Third Owner Ownership Percentage

Add Additional Owner

Remove

Fourth Owner Information

First Name

Last Name

Phone Number

Email Address

Date of Birth (MM/DD/YYYY)

Social Security Number

Address

Address 2

City

Zip Code

Fourth Owner Ownership Percentage

Remove

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:

I authorize Comdata Inc. to initiate electronic debit entries from the specified Load/Payment Method for the purpose of funding my Comdata Connect Card.

By pressing "Continue", 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, and represent and warrant that I am an authorized representative of the Applicant.

PAYMENT OPTIONS

IMPORTANT: Completing the payment information is required to submit your application for processing.

Please select how you would like your account to be set up and link a credit or debit card. You can change your selection or update your payment card at any time after your account is approved.

Option 1: Pay as you go

Comdata will automatically charge your linked credit or debit card each time you fuel with Connect card.

Limited time only: Pay cash price plus up to $.40 off at TA, plus pay cash price plus up to $.08 at other major truck stops.^*

Option 2: Preload funds

You will preload funds onto your account from your credit or debit card and use them for fuel purchases.

Limited time only: Pay cash price plus up to $.40 off at TA, plus pay cash price plus up to $.08 at other major truck stops.^*

Need help? Call us at 1-877-255-2865.

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OWNER CONTACT INFORMATION

Let's start with your contact info

BUSINESS INFORMATION

Hello First_Name, nice to meet you!

BUSINESS OWNER INFORMATION

Tell us more about the owner of Company_Name

Second Owner Information

Third Owner Information

Fourth Owner Information

Second Owner Information

Third Owner Information

Fourth Owner Information

Second Owner Information

Third Owner Information

Fourth Owner Information

PAYMENT OPTIONS

Get rewarded with up to $200 in account credits when you start fueling!*

Please tell us how would you like to fund your account.

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All done, First_Name.

Thank you! Your application is complete.