DriveProtect – UK Fuels Application Form Premium – Speeding Lawyers: Drive Protect

Thanks, we have received your one-off payment for your Premium Fuel Card. Now please complete the application to UK Fuels below. The Direct Debit will ONLY ever be used to take payment for fuel purchased using the card(s):

Member Fuel Card Application

The below application form is for the set up of your UK Fuels account. This data will be shared with UK Fuels and their terms and conditions can be reviewed here

Please fill in your details below:

Ref: Email Telephone Date Of Birth Address for Delivery Number of vehicles Estimated diesel usage per week litres

Standard Invoice / Payment Terms

Authorised Signatory Full Name Date Name to appear on Fuel Card/s Fuel Cards required (select the ones you want) BPShellEssoTexacoUK Fuels sites (garages such as Moto, Welcome Break, Murco, MFG, Co-Op & Applegreen)

Direct Debit Mandate

Instruction to your Bank or Building Society to pay by direct debit To: The manager Bank / Building society Bank or Building Society Address Name of account holder Bank or Building Society account number Branch Sort Code Please write your signature in the box below

You can read UK Fuels privacy policy here

Member Fuel Card Application

Please fill in your details below:

Standard Invoice / Payment Terms

Direct Debit Mandate

01843 232 791