3d fleet card medium

Have A C NRG Fleet Card But,

Don’t Have A Username Or Password Yet?

No Problem. Fill Out The Online Account Access Form.

Online Account Access Form

*Company Name

*Your Account Number

*Adress, City, State, Zip

Please print the name of your authorized personnel allowed to access C NRG Fleet's internet account management capabilities:

*Authorized Personnel Name 1

*Email

*Cell Phone

Authorized Personnel Name 2

Email

Cell Phone

By typing you name in the indicated fields, I release C NRG Fleet of any liability for any disputes or charges from transactions related to the internet. The passwords should be limited to the authorized personnel and any changes or deletions to the authorized personnel must be in writing and at least two business days in advance. Once this form is received, C NRG Fleet will contact you to assign the on-line passwords.

By typing your name in the indicated fields, you are agreeing to conduct business electronically with Cosby Oil Company Inc. a California corporation in accordance with the federal Electronic Signatures in Global and National Commerce Act (E-Sign), 15 U.S.C. ?? 7001, et seq. and California's Uniform Electronic Transactions Act, California Civil Code ?? 1633, et seq. Understand that transactions and/or signatures in records may not be denied legal effect solely because they are conducted, executed, or prepared in electronic form and that if a law requires a record or signature to be in writing, an electronic signature satisfies that requirement.

*Name

*Title