APPLICATION FORM FOR KEY FUELS ACCOUNT

1
PROGRESS INDUSTRIAL ESTATE, STATION ROAD, ROGIET,
NP26 3UE SALES_at_SEVERNFUELS.CO.UK [phone]
(MAIN) [phone] (FAX)
APPLICATION FORM FOR KEY FUELS ACCOUNT
Name ________________________________________ Add
ress ______________________________________ _____
_________________________________________ ________
______________________________________ ___________
___________________________________ Post Code
___________________ Tel No ______________________
_____ VAT Reg No _________________ Company Reg
No __________________ E - Mail address
________________________________ RDCO (if
applicable) ____________________________ Type of
Business _______________________________ Please
state if limited company ____________________ Ple
ase state if a Sole Trader ______________________
Name and address of proprietor
___________________________________________ ______
__________________________________________________
_____________ ____________________________________
_________________________________ Tel No
________________________________ Please state if
a Partnership _________________________________ P
artners 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
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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 ______________________ Pos
ition __________________________ 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
3
PROGRESS INDUSTRIAL ESTATE, STATION ROAD,
ROGIET, NP26 3UE SALES_at_SEVERNFUELS.CO.UK (01291)
42690 (MAIN) [phone] (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

• This Guarantee is offered by all Banks and
  Building Societies that take part in the Direct
  Debit Scheme
• The efficiency and security of the scheme is
  monitored and protected by your own Bank or
  Building Society
• If the amounts to be paid or the payment date
  change Severn Fuels Limited will notify you in 10
  working days in advance of your account being
  debited or as otherwise agreed.
• If an error is made by Severn Fuels Limited or
  your Bank / Building Society, you are guaranteed
  a full and immediate refund from your branch of
  the amount paid.
• You can cancel a Direct Debit at any time by
  writing to your Bank / Building Society. Please
  also send a copy of the letter to us.