Petroleum & Franchise Capital

Petroleum Finance Credit Application


Company Legal Name


Street Address



Zip Code

County Federal Tax ID #
Business Phone Fax Home Phone
Company Structure  
Year Started State Registered

Transaction Description:

Transaction Type: 
Real Estate Equipment Real Estate/Equipment

Borrower Information:

  Dealer   # of Sites Leased/Operated # of Sites Owned
  Distributor # of Sites Supplied # of Sites Owned/Operated
Experience (Years) Brand(s)


Finance Amount Down Payment (if any)

Information on Site(s) to be financed:

1. Address 2. Address
City/St/Zip City/St/Zip
Age Age
Operated Since Operated Since


Name Home Address Title
SS # City/St/Zip % Ownership
Name Home Address Title
SS # City/St/Zip % Ownership
Name Home Address Title
SS # City/St/Zip % Ownership
Name Home Address Title
SS # City/St/Zip % Ownership


Name of Primary Bank Contact
Account Number Phone  # of Years
Other Lender Reference Account Number Phone


Brand Supplier
Gallons/Month (Total) Contact Name Phone


Convenience Store Sales (Month) Car Wash Sales (Month)
QSR Concept Other
Sales (Month) Sales (Month)

I hereby authorize you to disclose the personal and/or business credit information set forth in this application. I hereby represent to Petroleum & Franchise Capital (PFC)  that such information is true, correct and complete. A photostatic copy of this authorization shall be as valid as the original.

I irrevocably authorize you to execute and file any UCC financing statement in my name which relates to the Equipment or this Lease. I agree to give you any financial information upon your request.

If my application for business credit is denied, I have the right to a written statement of the specific reasons for denial.  To obtain the statement, I will contact Operations Manager,  PFC, 33 Mill Plain Road, Danbury, CT 06811 or call (203) 778-1000 within 60 days from the date I am notified of your decision.  You will send me a written statement of reasons for the denial within 30 days of receiving my request for the statement.

Notice:  The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act.  The federal agency that administers compliance with the law concerning the creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC  20580.

The undersigned agrees that PFC has the right to confirm the accuracy of the above referenced credit information and that PFC has the right to accept or reject this lease application.


Please read the following terms and conditions carefully before submitting application. This is a legal document between PFC and you. 

This agreement, together with any such additional terms and conditions, are hereinafter referred to as this “Agreement”. PFC reserves the right, in its discretion, to change or modify all or any part of this Agreement at any time, effective immediately upon the posting thereof on the Web Site. You are responsible for regularly reviewing these terms and conditions. If at any time you find that the terms and conditions of this Agreement are no longer acceptable, you should immediately cease all use of the Service. 

2. I hereby understand that by submitting this form I am executing this Agreement with PFC and accept all of the terms and conditions of this Agreement and agree to be legally bound thereby.