New Account Application Form

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

PersonalBusiness

Personal Account Details
Account Name*
Customer's Full Name*
E-mail*
Phone*
Mobile*
Mailing Address*
Physical Address*
Post Code*
Post Code*
Drivers Licence #*
Version or 5b*
DOB*
Business Account Details
Business or Legal Name*
Directors Full Name*
Office Contact*
Position*
E-mail*
Work Phone*
Work Mobile*
Mailing Address*
Physical Address*
Post Code*
Post Code*

Credit References

No Power, Phone, Bank or Legal Companies
Business Name 1*
Contact Person*
Customer or A/C No.*
Address*
Phone*
Email*
Business Name 2
Contact Person
Customer or A/C No.
Address
Phone
Email

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

Additional Comments:
Terms & Conditions
Should be Empty: