EPIC Card Application

The business entity described below ("Company") makes application to EPIC Card Services ("EPIC") for an EPIC charge card, for commercial or business purposes only. Company has obtained permission to include application information that personally identifies an individual, including their consent to transfer, process, store, use and disclose it internationally for lawful purposes.

*Company's Legal Name:
*Beneficial Owner:
*Identification:
Date of Birth: / MM / DD YYYY
% of Ownership:
Street Address:
City:
State:
Country:
Company dba Name:
*President/Owner Name:
*Billing Contact Name:
*Billing Address
*Street Address

Address Line 2

*City

*State / Province / Region

*Postal / Zip Code

*Country
*Contact Telephone:
Fax:
*Email Address:
Shipping Address for EPIC Cards
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
*Federal Tax ID Number:
*Year of Company Registration:
Dun & Bradstreet Number:
Parent Company:
Parent Company Line of Business:
*Monthly Credit Line Requested:
*Annual Gallons of Fuel Purchased:
Financial Information
*Bank:
*Address:
*Contact Name:
*Telephone:
Fax:
*Account Number:
Flight Operations Information
*Contact Name:
*Position/Title:
*Telephone:
Fax:
*Email Address:
Hangar Address:
City:
State:
Zip:
*Base Airport Name and ICAO
*Does Company operate a fuel farm?
Yes No
*Area of Flight Operations: Domestic International

*Interested in Loyalty/Rewards Programs?

Yes No

Scheduling Software Used:
Referred By (FBO Name/IATA):
Aircraft Fleet List
*Number of Aircrafts:
Aircraft Comments:
Please state how you would like the name of your company to appear on all card(s):
Authorization Agreement & Submission

Company hereby applies for an EPIC Card and represents, warrants and agrees that all information is true and correct and that EPIC may, from time to time: (1) order credit reports and obtain other information on Company, from financial information listed; (2) use and disclose all information for verification and to maintain, enforce, and collect on any resulting account; and (3) furnish information to credit agencies and others, including affiliates.
By signing or submitting this application, Company agrees that it will be legally bound by the EPIC Card Account Agreement delivered with any card(s) issued if it does any of the following: (i) uses or allows others to use a card or fails to prevent use (including unauthorized use); (ii) activates a card (or allows others to do so) pursuant to instructions delivered with it; or (iii) without doing (i) or (ii), fails to terminate the card account within 30 days after its receipt of any card.
*Agree
*Company's Legal Name:
*Authorized Officer's Signature:
*Authorized Officer's Email:
*Print Name:
*Title:
*Date / MM / DD YYYY

EPIC Card Application

EPIC Card Application

Financial Information

Flight Operations Information

Aircraft Fleet List

Authorization Agreement & Submission