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Fuel Supply Request Form
FIU: RE/LB/076/2020
Date
*
-
Month
-
Day
Year
Date
Organization Name
*
LLC, Sole-Trader, Partnership, Joint Venture
Country
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
Website
Organization Representative/ Mandate
*
Mr.
Mrs.
Prefix
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
Please Upload: Company Profile /CIS/ KYC, Soft POF/ Bank RWA/ BCL
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What Product(s) are you interested in?
*
Aviation Kerosene Colonial Grade A1/ 54 Jet Fuel
Ultra-Low Sulphur Diesel EN590 10 PPM
Virgin Fuel Oil D6
Liquified Natural Gas
Calcined Petroleum Coke
Crude Oil
Gasoline 95 Octane
Low Grade D2 Diesel
Bitumen
Other
What is your preferred procedure?
*
Tank to Tank (TTT)
Tank to Vessel (TTV)
Tank Take Over (TTO)
Vessel to Tank (VTT)
Ship to Ship (STS)
Other
Please choose a mode of delivery
*
Free on Board (FOB)
Cost Insurance & Freight (CIF)
Have you had an active TSA/ CPA within the last 3 months
*
Yes
No
Please choose your preferred delivery port
*
Houston
Rotterdam
Fujairah
Other
Please tell us which facilities/ terminals your tanks are located?
*
What quantities are you looking for each product? Please indicate trial and contract values
*
Please choose contract duration
12 months
36 months
48 months
2+ years
Please tell us your target price(s) for each product
*
Do you have a verifiable POF / RWA / BCL from your bank? (No older than 3 months)
*
Yes
No
Are you closing and taking title using your own funds, or are you using funds from the exit buyer to close?
Are you currently buying to resell to a government agency/ military group, or are you buying to resell to a major company such as Amazon, FedEx, UPS or a major airline(s)?
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