New GOfuel Hot Rod Application Form

GOfuel HOT ROD Application Form
Before you fill out your application, if you have any questions please see our FAQ
or call us on 0800 42 83 83. Please note that all GOfuel Accounts are settled by Direct Debit.
I am willing to fill out a direct debit form*

Yes
How did you hear about us?*
Enter Club/ Group OR Promo Code if applicable

Personal Account Details

*If this application is for a BUSINESS account please go back and select the 'Business' option.
Account Name:*
Customer's Full Name*

PrefixFirst NameLast Name
Phone Number*

Area CodePhone Number
Mobile Number*

Area CodePhone Number
Email:*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityCountry

Postal Code
Is your Physical Address the same as the Mailing Address?

YesNo
Physical Address*

Street Address

Street Address Line 2

CityCountry

Postal Code
Alternative Contact Person (not living with you):

*This person may be contacted.
Contact Name:*

First NameLast Name
Contact Phone Number:*

Area CodePhone Number
Proof of Identification: Attach a copy of BOTH SIDES of your Driver's Licence AND proof of Addresses (a recent copy of an account showing your current address i.e. utility account.)
Driver's Licence:*
Version OR 5b Number:*
DOB:*

DayMonthYear
Attached Documents

Browse Files

Cancelof
Signature*

Clear

Business Account Details

* If this application is for a PERSONAL account please go back and select the 'Personal' option.
Account Name:*
Business OR Legal Name:*
Director/Owner's Full Name:*

PrefixFirst NameLast Name
Phone Number:*

Area CodePhone Number
Mobile Number:

Area CodePhone Number
Email:*
example@example.com
Office Contact Full Name:*

PrefixFirst NameLast Name
Position:*
Work Phone Number:*

Area CodePhone Number
Mobile Number:

Area CodePhone Number
Email:*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityCountry

Postal Code
Is your Physical Address the same as the Mailing Address?

YesNo
Physical Address*

Street Address

Street Address Line 2

CityCountry

Postal Code
Proof of Ownership: Attach a copy of BOTH SIDES of your Director/Owner's Driver's Licence AND a copy of the companies Certificate of Incorporation.
Director/Owner's Driver's Licence Name:*
Licence Number:*
Version OR 5b Number:*
DOB:*

DayMonthYear
Attached Documents

Browse Files

Cancelof

Direct Debit Form
NAME OF ACCOUNT (AS PER APPLICATION FORM):*
CONTACT PHONE NO:

Area CodePhone Number
DIRECT DEBIT AUTHORITY
ACCOUNT HOLDER NAME:ACCOUNT HOLDER NAME:*
BANK ACCOUNT FROM WHICH PAYMENTS TO BE MADE:*
(PLEASE ATTACH AN ENCODED DEPOSIT SLIP TO ENSURE YOUR NUMBER IS LOADED CORRECTLY)
ENCODED DEPOSIT SLIP

Browse Files

Cancelof
To: The Bank Manager,
Bank
Branch
Town/City
INFORMATION TO APPEAR ON MY/OUR BANK STATEMENT:
PAYER PARTICULARS
PAYER CODE
PAYER REFERENCE
Signature

Clear

How many Fuel Cards would you like?*
Note for customers ordering more than 5 cards: Since you require 5 or more cards, you will instead be emailed a spreadsheet upon completion of this form, which you must complete and return.

Personal Account Details