Fuels - Flint Hills Resources

New Customer Data Sheet

--CUSTOMER INFORMATION--
*Company Name:		*Tax ID No:
*Street Address:		P.O. Box No:
*City:
*State:		*Zip:
*Contact Name:		E-mail:
*Phone:		Fax:
--BUSINESS INFORMATION--
Retail Wholesale Retail & Wholesale
What is your annual unbranded gasoline demand? gallons
What is your annual unbranded diesel demand? gallons
Where are the primary terminals where you purchase products (include city and state)?
What is your primary interest regarding Flint Hills Resources?
Where are you interested in doing business?