Online Fuel Card Ordering Request for Glenwood Fueling Site Charge Card Completing this form will send a request to set up a charge card for the Glenwood Fueling Site. Please note we will require a credit application if you do not have charging capabilities set up on your CHS Prairie Lakes account. Name* First Last Farm Name (if applicable)Please enter any farm name that you operate under/your CHS Prairie Lakes account may be tied to.CHS Prairie Lakes Account Number, If KnownIf known, please enter your six digit CHS Prairie Lakes account number. If you do not have this number on-hand, our staff will be able to look it up based on your information above.Phone*Please list a phone number where you can be reached.Charge Account*Yes, I already have a charge account established with CHS Prairie Lakes. If this is not the case, please send me a credit application so we can get one set up.No, I do not have a charge account established with CHS Prairie Lakes. Please send me a credit application so we can get one set up.Please indicate whether you have a charge account with a line of credit already established with CHS Prairie Lakes. If you do not, we will send one to you to complete prior to issuing your charge card.Credit ApplicationPlease enter an email address or mailing address that we can send a credit application to, so we can get you set up with a charge account at CHS Prairie Lakes.Fuel Type*Cenex Ruby Fieldmaster (dyed fuel)Cenex Roadmaster XL (clear fuel)BothSelect which fuel you'd like the card to be authorized for. This iframe contains the logic required to handle Ajax powered Gravity Forms.
