Membership Dues Update

Membership Dues Collection Card

Monthly Dues for all the Filling Stations
Name of Station*
Numbers of Station*
State*
L.G.A*
Addresses (if more than one indicate the address)*
Year*
Months
prevnext( X )
January2,000.00NGN

February 2,000.00NGN

March2,000.00NGN

April2,000.00NGN

May2,000.00NGN

June2,000.00NGN

July2,000.00NGN

August2,000.00NGN

September2,000.00NGN

October2,000.00NGN

November2,000.00NGN

December2,000.00NGN

Subtotal 0.00NGNTax 0.00NGNTotal 0.00NGN
ACCOUNT DETAILS
Polaris Bank
Account Number: 4091737064
POLARIS BANK, after payment send your receipt via whatsapp or call this Numbers: 08057875873
Your Name*

First NameLast Name
Your E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

Membership Dues Collection Card