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Online Fuel Card Application

 

  • Please complete all the fields marked with an asterisk and the relevant parts of the application form.
  • Before you begin the application, please have all your company, vehicle and bank information ready.
  •  If at any point during the process you have any problems completing the application, contact us on 0800 612 6132
  • Before you click ‘Submit‘, check the information you have entered is correct by clicking on the ‘Summary‘ button.
  • This application will not time out.

 

Note: If you want to apply via snail mail click here

 

Card Details

Customize your fuel cards with your company name, vehicle details or drivers details

  • General Business Information
  • Additional Information
  • Fuel Card Selection
  • Card Details
  • Direct Debit Information

General Business Information

Company

Contact

Position

Address

Postcode

Telephone

Mobile

Email

Nature of Business

Established Year

VAT No

Additional for Limited Companies Only

Registered No.

Managing Director

Company Secretary

Additional for Sole Traders / Partnerships Only - First Principle

Name

Address

Postcode

Are you a homeowner or tenant? (Applications must be supported by a homeowner)

Date of Birth

Telephone

Mobile

Additional for Sole Traders / Partnerships Only - Second Principle

Name

Address

Postcode

Are you a homeowner or tenant? (Applications must be supported by a homeowner)

Telephone

Mobile

Fuel Card Selection

Please select the card you require

Trade References

First Referee Name

First Referee Telephone

Second Referee Name

Second Referee Telephone

Account Usage

Monthly Credit Required (£)

Number of Vehicles (Diesel/Petrol)

Monthly Fuel Expenditure (£) (Diesel/Petrol)

Embossing Information

Total number of cards required

Company Name (Max 20 letters)

Vehicle Registration Number and / or drivers name (Max 20 letters)

Vehicle Registration Number and / or drivers name (Max 20 letters)

Vehicle Registration Number and / or drivers name (Max 20 letters)

Vehicle Registration Number and / or drivers name (Max 20 letters)

Vehicle Registration Number and / or drivers name (Max 20 letters)

If you require more than 8 cards, please enter the details here on seperate lines, max 20 letters per line

Card Fraud Protection (£1+vat, per card, per month)

Do you require Card Fraud Protection?

On Line Account Access (OLA)

Login Name

Password

Any Other Information

Enter any other important information here

Instruction to your Bank or Building Society to pay by Direct Debit

Bank / Building Society

Address

Postcode

Account Name

Sort Code

Account No.

direct-debit-guarantee