GOfuel Account Application Form RNZYS New

GOfuel Application RNZYS
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

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 *

Prefix First Name Last Name
Phone Number *

Area Code Phone Number
Mobile Number *

Area Code Phone Number
Email: *
example@example.com
Mailing Address *

Street Address

Street Address Line 2

City Country

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

Yes No
Physical Address *

Street Address

Street Address Line 2

City Country

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

*This person may be contacted.
Contact Name: *

First Name Last Name
Contact Phone Number: *

Area Code Phone 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: *

Day Month Year
Please attached copy of Drivers License and other relevant Documents

Browse Files

Cancel of
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: *

Prefix First Name Last Name
Phone Number: *

Area Code Phone Number
Mobile Number:

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

Prefix First Name Last Name
Position: *
Work Phone Number: *

Area Code Phone Number
Mobile Number:

Area Code Phone Number
Email: *
example@example.com
Mailing Address *

Street Address

Street Address Line 2

City Country

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

Yes No
Physical Address *

Street Address

Street Address Line 2

City Country

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: *

Day Month Year
Attached Documents

Browse Files

Cancel of
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.

** Cards ordered for Marine use: Mobil cards work at all our marina. BP cards are also available but only work at certain marinas.

GOfuel Application RNZYS