Open a Residential account with Globe Petroleum, providing you with petroleum, oils, diesel fuel, fuel oil, gasoline, fleet fueling, lubricants, residential heating oil, commercial fuels, marine gasoline, and more by such name brands as Citgo.

ACH Authorization Form

Please fill in the form below and submit.
All Sections must be completed in full.

AUTOMATED CLEARING HOUSE (ACH) AUTHORIZATION FORM
I (we) authorize GLOBE PETROLEUM INC, herinafter call the Company, to initiate entries (Debit and/or credit) to my (our) account at the Financial Insitution indicated below. PLEASE PROVIDE A VOIDED CHECK
Your Bank Name	Account Name
City, State, Zip	Account Number
ABA Routing Transit Number	Type Of Account:
This authorization is to remain in full force and effect until the Company has received written notification from me (us)of its termination in such time and in such manner as to afford the Company a reasonable opportunity to act on it.
Your Name	Account #
Authorized Signature	Date
Authorized Signature (Join Account)	Date

CREDIT CARD AUTHORIZATION AGREEMENT
I authorize Globe Petroleum Inc. to automatically bill my credit card account (10) days after each delivery date.
Card Type:
Credit Card Number	Expiration Date
Signature	Name as show on card
This authorization is to remain in full force and effect until the Company has received written notification from me (us)of its termination in such time and in such manner as to afford the Company a reasonable opportunity to act on it.


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