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 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