Member Fuel Card Application

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

Address

Name of account holder

Bank or Building Society account number

Branch Sort Code

The details above will be used by UK Fuels to take payment for the fuel purchased when you use your fuel card.
I authorise Drive Protect Ltd to use the same bank details above to set up my monthly £3/month Direct Debit, which I can cancel at any time to downgrade to the free card.

Please write your signature in the box below

You can read UK Fuels privacy policy here