Customer Account Information

GM Approved Program Type *

GM FAN Number *

Referral Source

Business Type: *

Company Legal Name: *

DBA:

Legal Physical Address: *

Address 2

City *

Country *

State *

Zip Code *

Tax ID: *

Tax ID/Social Security Number: *

Language *

English

French

Currency: *

USD

Is this Location a Corporate Office or HQ with Multiple Locations? *

Yes

No

Do you have satellite or additional locations that need to be listed? *

Yes

No

Is there a Corporate Office or HQ with a current GM Fleet Consolidated Billing Account? *

Yes

No

Credit Request

Requested Credit Line: *

Expected Monthly Spend *