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HomeMy WebLinkAboutADDENDUM TO THE FUEL CARD SERVICES AGREEMENT BETWEEN WRIGHT EXPRESS FINANCIAL SERVICES AND STATE OF GA ADDENDUM TO THE FUEL CARD SERVICES AGREEMENT BETWEEN WRIGHT EXPRESS FINANCIAL SERVICES CORPORATION ("WEX FSC") AND THE STATE OF GEORGIA (the "STATE") � .• . Participating Entity agrees that in the event the account is not paid as agreed, WEX FSC may report the undersigned's liability for and the status of the account to credit bureaus and others who may lawfully receive such information. Participating Entity Phone # Fax# Augusta, Georgia 706-821-2334 706-821-2855 Headquarters Name and Physical Address (Do not include PO Box) ApplicanYs Taxpayer ID #(TIN, FEIN or SSN) Augusta, GA, Room 105, 530 Greene Street, Augusta, GA 30901 582204274 In Business Si�ce (yyyy) Year of Incorporation (yyyy) Number of Vehicles Avg Monthly Fuel Expenditures Avg Monthly Service Expenditures January 1, 1996 January 1, 1996 1434 $ 345,000 $ N/A . .• . Write Participating Entity name as you wish it to appear on cards. Limit of 20 characters & spaces. Unless specified, no company name will appear on cards. 00000a0000❑ooa❑❑❑❑o❑ Billing Contact Billing Address City State Zip+4 Patricia Ystenes 1568 Broad Street Augusta GA 30904 Designate the Fleet Contact authorized to receive all charge cards, reports, and other such information we provide from time to time and to take actions with respect to your account and account access. This is also the person designated by your company to provide all fleet vehicles, driver and other information we may request. Authorized Fleet Contact Name Titie Phone # Fax # Patricia Ystenes Admin Assistant 706-821-2845 706-821-1498 Mailing Address (if different from billing address) City State Zip+4 Email address (required to take advantage of product type card controls) pystenes @ aug ustaga. gov Card Controls: To help estimate your needs, indicate the types of cards you anticipate using. All Products ❑ Fuel & Service ❑� Mix of card types If ou rovide a valid email address above ou can select from these roduct e o tions: Fuel & Fluids w/Roadside Assistance ❑ Fuel w/Roadside Assistance � Check here if business is exempt from motor fuels tax DEFINITIONS "AgreemenY' means: Contract No. SWC 999999-SPD-120100730-001 effective Februarv 23. 2006 for Fuel Cards and Fuel Management Services (the "AgreemenY') between the (the State and WEX FSC). "Participating Entity" shall mean the Participating Entity as defined in the Agreement permitted to purchase services under the Agreement, as specified in the Credit Information above. All other capitalized terms used in this Addendum without definition have the meanings set forth in the Agreement. AGREEMENTS OF WEX FSC AND PARTICIPATING ENTITY: 1. This Addendum is to allow the Participating Entity to participate under the Agreement between WEX FSC and the State. It does not modify, amend or change the Agreement in any way. 2. Participating Entity represents that it is authorized or allowed by the laws of its home state to enter into this Addendum and to participate under the Agreement. 3. Participating Entity hereby requests the services of WEX FSC described in the Agreement and agrees to perform ali duties of a Participating Entity under the Agreement, including, without limitation, payment of all charges on its account(s) within the time periods provided under the Agreement, payment of any fees provided in the Agreement, and cooperation with respect to providing all necessary information for the administration of the Agreement. Participating Entity agrees to be bound by the terms and conditions of the Agreement, including, without limitation, rules for authorized and unauthorized use of cards, disputes of charges, reporting lost and stolen cards, and all other rules and provisions relating to use of Participating Entity's account. 4. Participating Entity acknowledges that its failure to make timely payment in accordance with the terms of the Agreement and/or the Addendum may result in suspension or cancellation of the account(s). The undersigned represents and warrants that he/she is duly authorized to execute this Addendum on behalf of the Participating Entity and this Addendum is the valid and binding obligation of the Participating Entity, enforceable in accordance with its terms. REBATE: You may be offered discounts and/or rebates by participating under this Agreement from time to time. Such discounts and/or rebates may be suspended, modified or discontinued at any time without prior notice and may not be appiicable to all fuel types. In addition, certain conditions in order to earn or receive the rebate or discount such as but not limited to maintaining your account in good standing will apply and be provided to you when such offers are made. INFORMATION SHARING DISCLOSURE: Information regarding your transactions may be provided to accepting merchants or their service providers to facilitate discounts or other promotional campaigns of interest to you. U.S.A. PATRIOT ACT: Our bank complies with Section 326 of the USA PATRIOT Act which requires all financial institutions to obtain, verify, and record information that identifies each company or person who opens an account. What this means for you: when you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents for your business. DISCLAIMER: THIS IS AN APPLICATION FOR SERVICES AND SHALL NOT BE BINDING UPON WEX FSC UNTIL FINAL CREDIT APPROVAL HAS BEEN GRANTED BY WEX FSC. . .� � . . Any person signing on behalf of the Partici ating Entity h s been dul uthorized by all necessary action of ApplicanYs governing body, and that the undersigned is authorized to make this ap cation b If the Pa ''patin dy. Signature: Printed Name: Frederick L. Russell Title: inistrator, Augusta, GA Date: !a.—dl—�1 Complete and sign addendum. Fax to 1-866-527-8873 •-• Oppty Number Sales Code Plastic Type Coupon Code Account Number • GAFU GA6 04 04.ADDEND.CRDAPP (11/08)