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Exp. Month

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Check Type*

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First Name *

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Zip Code *

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Jernigan Oil Account Information

Please enter Jernigan Oil account number:

Acct Type (Fuel Acct or Duck Thru Fleet Card Acct):

Disclosures

All Commercial and Fleet Card Accounts will be assessed a 2% Credit Card Processing Fee.

I hereby authorize the Jernigan Oil Co., Inc. to Debit or Credit the Bank Account referenced herein, via the Automated Clearing House system, according to the parameters specified herein. This authority will remain in effect until the payment(s) are completed as specified herein. Furthermore, I authorize Jernigan Oil Co., Inc. to debit, if the payment is returned for any reason, a rejected/returned item fee of $35.

Please allow up to 3 days for payment processing.

I have read and accept the above disclosures.

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