The eflatbed.com Fuel Card+
SM
Fill in the form below for additional information on the eflatbed.com Fuel Card+
SM
.
Required fields are displayed in red.
Submitted By:
Name
E-mail
Telephone
(
)
-
ext
Carrier Information:
Carrier Name
Contact
Address 1
City
Address 2
State
Please Select...
ALBERTA
ALASKA
ALABAMA
ARKANSAS
ARIZONA
BRITISH COLUMBIA
CALIFORNIA
COLORADO
CONNECTICUT
DISTRICT OF COLUMBIA
DELAWARE
FLORIDA
GEORGIA
HAWAII
IOWA
IDAHO
ILLINOIS
INDIANA
KANSAS
KENTUCKY
LOUISIANA
MASSACHUSETTS
MANITOBA
MARYLAND
MAINE
MICHIGAN
MINNESOTA
MISSOURI
MISSISSIPPI
MONTANA
MEXICO
NEW BRUNSWICK
NORTH CAROLINA
NORTH DAKOTA
NEBRASKA
NEWFOUNDLAND
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NOVA SCOTIA
NORTHWEST TERRITORY
NEVADA
NEW YORK
OHIO
OKLAHOMA
ONTARIO
OREGON
PENNSYLVANIA
PRINCE EDWARD ISLAND
QUEBEC
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
SASKATCHEWAN
TENNESSEE
TEXAS
UTAH
VIRGINIA
VERMONT
WASHINGTON
WISCONSIN
WEST VIRGINIA
WYOMING
YUKON
Zip
E-mail
Telephone
(
)
-
Fax
(
)
-
ID
Web Site
Fuel Card Questions
1. Who is your current fuel card provider:
EFS
Comdata
TCH
Transplatinum
Other
None
A. What are the current payment terms?
B. What is the current fuel card
funded
transaction fee?
C. What is the current fuel card
direct bill
transaction fee?
D. What are the current express code fees (checks)?
E. Please state the number of fuel card transactions completed per month.
F. Please state the number of express code transactions completed per month.
G. Are you able to receive cash with this card?
Yes
No
2. How many trucks are in your fleet?
3. Type of Carrier:
Local
Less than truckload
Truckload carrier
4. Are you interested in additional products and services offered by T-Chek? If so, please check the appropriate boxes below.
Phone Card
Funds Distribution (ATMJ, payroll card options, debit card options, etc.)
e-Stop Fuel Information Tool kit (Truckstop and wholesale fuel price information)
Fuel Management Services
Advantage Fuel Network (Free transaction fee paid program)
Regulatory and Compliance Services (Fuel tax services, driver log services, etc)
Software / Technical Questions
1. What operating system are you currently using?
2. What industry software are you currently using?
3. If a software system, which one?
4. Do you process EDI shipments?
Yes
No
5. Do you process payroll and fuel tax in-house?
Yes
No
6. Do you have Internet access?
Yes
No
For additional questions, please call Stacey Schultz at 1.877.767.2435 ext. 3037
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