Fikes Wholesale, Inc.

First Name

Last Name

Company

Title

Type of Business

Federal Tax ID or SSN

Street Address

City

State

ZIP Code

Mailing Address (If different)

City

State

Zip Code

Phone Number

Preferred Pricing Contact Method

Enter E-Mail Address or Fax Number

TCEQ Facility ID

Tank Gallons Regular

Tank Gallons Plus

Tank Gallons Super

Tank Gallons Diesel

Tank Gallons Other

I`d like pricing for the following product(s):

   Regular Unlead
   Mid-Grade Unlead
   Premium Unlead
   Diesel
   Dyed Diesel

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