Fuel Discount Program

Pre-Application

The AITA Fuel Program Administrator will be in contact with you within 1 business day to discuss the next step in the enrollment process.

Please contact me regarding the AITA Fuel Discount Card Program. *

By checking this box you give the AITA Fuel Program Administrator permission to contact you regarding the AITA Fuel Discount Program.

Company Legal Name *

DBA Name(s): *

Number of Trucks? *

Physical Street Address *

City *

State *

Zip Code *

DOT# *

MC# (or "N/A" if not applicable):

Primary Contact Name: *

Title: *

Email Address *

Office Phone: *

Mobile Phone: *

Correspondence preference: *

Mobile Phone

Office Phone

Do you currently have a fuel card program? *

If yes, please state your current program.

If you currently have a fuel program would you be interested in a Free Fuel Analysis? *

Yes

No

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