Global Fuel Recovery Online Form

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Global Fuel Recovery, LLC
832-699-0045

Date(*)

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Quote Number(*)

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Business Information

Generator / Shipper(*)

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Phone(*)

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Fax

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Address(*)

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City(*)

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State(*)

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Zip(*)

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Contact 1(*)

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Contact 1 Title(*)

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Contact 2(*)

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Contact 2 Title(*)

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Billing Address(*)

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Attention

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Billing City(*)

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Billing State(*)

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Billing Zip(*)

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Federal EPA ID #

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Credit

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PO#

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Services

Contracted Truck Charge

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$ Per Hr Load

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Total $

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Demurrage

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$ Per Hr

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Total $

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Vacuum Truck Hours

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$ Per Hr

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Total $

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Mileage

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$ Per Mile

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Total $

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Foreman Hours

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$ Per Hr

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Total $

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Labor Hours

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$ Per Hr

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Total $

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Equipment Rental

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$ Per Hr/Day

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Total $

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Equipment Rental

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$ Per Hr/Day

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Total $

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Other

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$ Per Hr/Day

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Total $

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Services Continued

Gal Oil

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$ Per Gal

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Total $

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RCF

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Please enter Total $

Gal Water

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$ Per Gal

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Total $

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Gal Antifreeze

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$ Per Gal

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Total $

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Oil Filters - Drums

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$ Per Drum

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Total $

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Gal Sludge / Sumps

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$ Per Gal

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Total $

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Dirt-Tons

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$ Per Ton

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Total $

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Truck Hours

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$ Per Hr

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Total $

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Dirt Absorbent

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$ Per Drum

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Total $

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$ Tank Bottoms

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$ Per Gal

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Total $

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Oil Dri Products

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$ Per

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Total $

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Testing

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$ Per Test

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Total $

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Set-up Charge

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$ Per Each

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Total $

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Misc / Service Charge

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$ Per Each

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Total $

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Agreement

The initial term of this agreement shall commence on the date hereof (above) and shall continue for the term of

Years

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Thereafter, the Agreement shall remain in affect until either party terminates this Agreement on not less than thirty (30) days prior written notice or (b) the parties enter into a new contract with respect to the collection of Materials from Customer locations

Tank Size

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Frequency

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Stop #

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Market Area

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Customer Type

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Tank Size

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Frequency

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Stop #

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Market Area

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Customer Type

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Global Fuel Recovery Representative's Signature(*)

Sign Above

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Salesman Code(*)

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Customer Representative(*)

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Special Instructions

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