PROGRESS INDUSTRIAL ESTATE, STATION ROAD, ROGIET, NP26 3UE
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APPLICATION FORM FOR FUEL CARD ACCOUNT PowerPoint PPT Presentation


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PROGRESS INDUSTRIAL ESTATE, STATION ROAD, ROGIET, NP26 3UE [email protected] (01291) 426900 (MAIN) (01291) 426901 (FAX). APPLICATION FORM FOR FUEL CARD ACCOUNT. Name: ________________________________________ Address: ______________________________________

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APPLICATION FORM FOR FUEL CARD ACCOUNT

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Application form for fuel card account

PROGRESS INDUSTRIAL ESTATE, STATION ROAD, ROGIET, NP26 3UE

[email protected]

(01291) 426900 (MAIN)

(01291) 426901 (FAX)

APPLICATION FORM FOR FUEL CARD ACCOUNT

Name: ________________________________________

Address: ______________________________________

______________________________________________

______________________________________________

______________________________________________

Post Code: ___________________Tel No: ___________________________

VAT Reg No: _________________Company Reg No: __________________

E - Mail address: ________________________________

RDCO (if applicable): ____________________________

Type of Business: _________________ Market Sector: ___________________

Please state if limited company: ____________________

Please state if a Sole Trader: ______________________

Name and address of proprietor: ___________________________________________

_____________________________________________________________________

_____________________________________________________________________

Tel No: ________________________________

Please state if a Partnership: _________________________________

Partners name, addresses and telephone Numbers:

1) _______________________________

_________________________________

_________________________________

_________________________________

_________________________________

TEL No: __________________________

2) _______________________________

_________________________________

_________________________________

_________________________________

_________________________________

TEL No: __________________________

YOUR LEADING FUELS AND LUBRICANTS SUPPLIER

Registered in England No: 1560715, 1121025. Directors: MJ Mould, AG Mould


Application form for fuel card account

Please state if part of a group (if yes please give details): ____________________

__________________________________________________________________

__________________________________________________________________

Amount of Monthly Credit Sought: ______________________

Credit sought with (please tick): Severn Fuels Ltd

Production Lubricants Ltd

Name of Bank: _____________________________________

Account Number: ___________________________________

Sort Code: ________________________________________

Trade References

Name: __________________________Tel No: ___________________________

Name: __________________________Tel No: ___________________________

Application signed on behalf of: ________________________________________

Signed and Accepted by: _______________________________

Print Name: ______________________Position: __________________________

Date: ___________________________

STANDARD PAYMENT TERMS ARE BY DIRECT DEBIT

14 DAYS FROM DATE OF INVOICE

Signing of this form confirms that we have read and accepted the Terms and Conditions of Sale.

Every effort will be made to process this application as soon as possible and you will be notified in writing once this has been completed.

Until such time, however, our supply terms are on either cash with order or cash on delivery basis.

YOUR LEADING FUELS AND LUBRICANTS SUPPLIER

Registered in England No: 1560715, 1121025. Directors: MJ Mould, AG Mould


Application form for fuel card account

PROGRESS INDUSTRIAL ESTATE,

STATION ROAD, ROGIET, NP26 3UE

[email protected]

(01291) 42690 (MAIN)

(01291) 426901 (FAX)

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

Please fill in the whole form using a ball point pen and send it to:

SEVERN FUELS / PRODUCTION LUBRICANTS

PROGRESS INDUSTRIAL ESTATE,

STATION ROAD,

ROGIET, Nr NEWPORT, MONMOUTHSHIRE, NP26 3UE

Originators Identification Number

9

8

0

6

1

6

Reference Number

Name(s) of Account Holder(s)

Instruction to your Bank or Building Society

Please pay Severn Fuels / Production Lubricants Limited Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Severn Fuels Limited and, if so, details will be passed electronically to my Bank / Building Society.

Bank / Building Society Account Number

Branch Sort Code

Name and full postal address of your Bank or

Building Society

Signature(s)

To the Manager

Bank/Building Society

Address

Postcode

Date

Banks and Build Societies may not accept Direct Debit instructions for some types of account

Cut along dotted line and to be retained by the Payer

The Direct Debit Guarantee

  • The Guarantee is offered by all Banks and Building Societies that accept instructions to pay Direct Debits

  • If there are any changes to the amount, date or frequency of your Direct Debit, Severn Fuels / Production Lubricants will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Severn Fuels / Production Lubricants to collect a payment, confirmation of the amount and date will be given to you at the time of the request

  • If an error is made in the payment of your Direct Debit, by Severn Fuels / Production Lubricants or your Bank or Building Society you are entitled to a full and immediate refund of the amount paid from your Bank or Building Society

  • If you receive a refund you are not entitled to, you must pay it back when Severn Fuels / Production Lubricants asks you to

  • You can cancel a Direct Debit at any time by simply contacting your Bank or Building Society. Written confirmation may be required. Please also notify us


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