ONLINE CONSUMER CREDIT APPLICATION

It is FAST, EASY, and SECURE!

No need to carry cash. And you have a complete record of your purchases. Best of all, YOU CAN SAVE MONEY!! Please fill out this Application and Agreement for 30-Day Charge Account completely before proceeding.

You will receive a statement every month that details all your purchases. When you pay your statement in full and on-time, you receive an additional 3 cents per gallon discount off already competitive Aloha prices.

IMPORTANT:
If you return to this page from the next page and wish to make a change, then you must click on the Proceed to Next Page button below, in order for any changes to take effect. If you merely click on the browser's Forward button, then any changes will be ignored.

This form must be completed within 45 minutes or you will be required to restart.
Date: 
Title (optional):  Mr.  Mrs.  Miss  Ms.  Other:
Last Name
 First
 Middle
Street Address
City
 State
 Zip Code
Home Phone
 Business Phone
 E-Mail
Date of Birth (MM/DD/YY)
 Social Security Number
Present Housing:  Own  Rent  Live with Parents
Information on nearest relative not living with you:
Name Phone
Your Employer
 Years
 Months
 Occupation
Bank Reference
Affinity Group - click on name or leave at "(none)":
Estimated Monthly Charges: $ (only round number without decimal point or comma)

Please specify the number of cards which you desire, and enter the name(s) exactly as you want them to appear on your card(s).

Number of cards:   (must agree with the number of names entered below)*
  Name (maximum 21 characters)
Card 1
Card 2
Card 3
*If you would like more than 3 cards, then please send an E-Mail message to giving your name (as entered above) and the names for additional cards.

Please note the fees and payment requirements:

Annual Fees
Transaction Fee for Purchase
Fees for Paying Late
Annual fee: None
Membership fee: $5 one-time only
None
 Late Payment Fee: 1˝% per month on Average Daily Balance for prior Billing Period
All charges made on this charge card are due and payable when you receive your periodic statement.

Information about the cost of the Save-A-$ Club® card in this application is accurate as of April, 2008. This information may change after that date. To find out what may have changed, write us at Save-A-$ Club of Hawaii, P.O. Box 500, Honolulu, Hawaii 96809. Send no payment with application. Membership fee will be charged to your account if approved. A charge of one dollar ($1.00) per card will be billed to your account when more than two (2) cards are requested.


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Copyright © 2000-2008 Aloha® Petroleum, Ltd. All rights reserved.

Last modified: April 2, 2008