IMPORTANT FORMS
We ask all new customers to fill out a Credit Application
Completed forms from Indiana customers may be faxed to 812-372-6801, mailed to PO BOX 304, Seymour, IN 47274, or dropped off at 811 W. 2nd Street, Seymour, IN 47274.
Completed forms from Ohio customers may be faxed to 513-367-6876, or mailed or dropped off at 111 May Drive, Harrison, OH 45030.
Individual Credit Application: If you are an individual seeking our products or services, click to download a copy of our credit application.
Commercial Credit Application: If you are a commercial business or organization, click to download a copy of our credit application.
Gas Card Application: Apply for the Premier Companies card and use it when you purchase fuel to get a 5-cent/gallon discount.
Additional Documents
ST105 Tax Exempt Form: Indiana registered retail merchants and businesses located outside Indiana may use this certificate to claim a sales tax exemption for valid purchases.
ACH Credit Form (Grain Payments)
Indiana GT-105 Gasoline Use Tax Exemption Certificate.
Indiana GA-110L Claim for Refund
Indiana REF-1000 Claim for Fuel Tax Refund
Kentucky 72A110 Certification of Motor Fuels Nonhighway Use
Kentucky 72A135 Application Motor Fuel Tax Refund Permit
Kentucky 51A158 Farm Exemption Certificate for Sales Tax
Employee Application: View Available Positions and Apply
Input Financing Loan Application
Premier Membership Application
W9 Form: W9 Request for Taxpayer Identification Number and Certification