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87E10

May_15

1 1.91
2 1.92
3 1.92
4 1.92
5 1.94
6 1.94
7 1.94
8 1.91
9 1.91
10 H
11
12 1.95
13 1.97
14 2.02
15 2.07
16 H
17
18 2.07
19 2.07
20 2.05
21 2.05
22 2.10
23 2.09
24 H
25
26 2.03
27 2.03
28 1.98
29 2.04
30 2.10


                   IGSOA - Membership Form

               Print it & Fax to : (937) 435-5556 

CURRENT BRAND LABEL
 

________________________________________

Total Tanks: ______  Gasoline:_____   Diesel:_______

Total Capacity: (Gas)___________  (Diesel) ________

 

CURRENT FUEL SUPPLIER

Company Name: _____________________________

Contact Person Name: ___________________________

Address: _____________________________________

City, State: ________________Zip ________________

Email: _____________________Website: _____________________

 

GAS COMPANY CREDIT CARD PROGRAM (if any) 

Company Name: ______________________________________

Contact Person Name: ______________________________________

Address: ________________________________________________

City, State: _______________Zip ________________

Email: _____________________Website: _____________________

 

PER MONTH AVERAGE SALES

 

Grocery:___________ Gallons (Gas): _________ (Diesel): ________

Lottery Commission Per Month: ____________________________

 

SECURITY DEPOSIT WITH FUEL SUPPLIER

YES: ______________  NO: ________________

(IF YES) HOW MUCH: $_________________

 

 

Tell us more about you and your other retail locations

 

Address

 
 

 

 Referred By Who ? 

 

 

Print & Fax to : (937) 435-5556

 

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Last modified: Saturday June 20, 2015.