KHI Card Processing Merchant Enrollment Form

To ensure the quickest set up possible, fields marked with an * are required for completion. Merchant enrollment into the card programs will not progress until all required data has been provided. If you need to leave this page before completion, please use the Save and Return feature so you do not lose your work.

Save & Return

Use an account to return to saved work.

Person Completing Form

Please enter information for the person completing this form. You will be emailed upon submission with all information presented.

Name of person completing form: *

Email Address of the person filling out this form: *

Completed on Date: * +

By checking this box, I agree to conduct business electronically. *

I Agree

I would like to enroll as a Merchant for the: *

AIR Card Program (U.S. Government Aviation Fuel Card Program)

RESQ Card Program (First Responder Aviation Fuel Card Program)

SEA Card Program (U.S. Government Marine Fuel Procurement Program)

Merchant Information

Legal Business Name: *

DBA: 🛈

Supplier: 🛈

Sam.gov Unique ID: 🛈

DUNS Number: 🛈

Physical Location Information

Main General Phone Number: *

Main Business Email Address: *

Main General Fax Number:

Legal Physical Business Address 1: *

Legal Physical Business Address 2:

Country: *

City: *

Full State / Province Name: *

Postal/ZIP Code:

Financial / Remittance Information

Main Financial Phone Number: *

Main Financial Email Address: *

Main Financial Fax Number:

Is your Financial / Remittance address different than above? *

Yes

No

Financial Business Address 1: *

Financial Business Address 2:

Country: *

City: *

State / Province: *

Postal/ZIP Code:

Parent Company

Do you have a Parent Company with different information than what has been disclosed above? *

Yes

No

Parent Company Name: *

Parent Company Phone Number: *

Parent Company Email: *

Parent Company Fax Number:

Physical Parent Business Address 1:

Physical Parent Business Address 2:

Country:

City:

State / Province: *

Postal/Zip Code: *

Primary Contacts

Physical Contact Name: * 🛈

Physical Contact Email: *

Physical Contact Phone Number: *

Receive Reports?

Yes

No

Remittance Contact Name: *

Remittance Contact Email: *

Remittance Contact Phone Number: *

Receive Reports? *

Yes

No

Primary Ordering Contact *

Primary Ordering Contact Email: *

Primary Ordering Contact Phone Number: *

Receive Reports *

Yes

No

Is the Remittance Contact the contact who should receive chargeback notifications? *

Yes

No

Please enter the information below for the Chargeback Contact.

Chargeback Contact: *

Chargeback Contact Email: *

Chargeback Contact Phone Number: *

Receive Reports?

Yes

No

Would you like to enter any additional contacts? *

Yes

No

Please enter up to 3 additional contacts.

Additional Contact 1 Name:

Additional Contact 1 Email:

Additional Contact 1 Phone Number:

Additional Contact 1 Title:

Receive Reports?

Yes

No

Additional Contact 2 Name:

Additional Contact 2 Email:

Additional Contact 2 Phone Number:

Additional Contact 2 Title:

Receive Reports?

Yes

No

Additional Contact 3 Name:

Additional Contact 3 Email:

Additional Contact 3 Phone Number:

Additional Contact 3 Title:

Receive Reports?

Yes

No

If you would like to set up more additional contacts, please advise the support team upon setup of account.

Tax Information

In accordance with the laws of the United States Internal Revenue Service, KHI is required to obtain a completed W-9 from all merchants based within the United States. For companies outside of the United States, a W-8 form or the enclosed W-8 Substitution form is required. Your merchant account will NOT be completed without one of the below forms. Please select which form is to be submitted.

W-9

W-8

W-8 Substitution

Please attach a current and signed W-9: *

Please attach a current W-8 or Substitution: *

Invoice Submission Method

Please select the way in which you would like to submit your invoices: *

Electronic (KHI certified and approved)

Paper (Email, Fax, Courier) ** Note: an additional fee of up to $40 (per invoice) may apply. See Service Fee Table in Merchant Agreement.

Other

Do you already utilize an online Point of Sale Software to electronically process your transactions? *

Yes

No

Please specify the Point of Sale software you are currently using to ensure compatibility: *

Email is the preferred submission method if you are not electronically sending invoices to us. For the AIR Card program, you will send invoices to invoices@aircardsys.com. For the RESQ Card program, you will send invoices to invoices@resqcard.com.

A KHI representative will reach out to discuss your invoice submission choice.

In order to avoid the "up to $40" Paper Invoice Fee, would you like to be set up to use our FREE online Point of Sale software (AvPOS) to process your KHI Card Program transactions? *

Yes

No

AIR Card® Operations

6450 Sprint Parkway | Overland Park, Kansas 66251
Phone: +1 (866) 308-3811 | Fax: +1 (913) 271-9358
support@aircardsys.com | www.khinc.com

KHI Card® Operations

6450 Sprint Parkway | Overland Park, Kansas 66251
Phone: +1 (877) 627-5151
merchant@resqcard.com | www.khinc.com

SEA Card® Operations

6450 Sprint Parkway | Overland Park, Kansas 66251 USA
Phone: +1 (866) 308-5475
support@seacardsys.com | www.khinc.com