Application Form

Simply complete ALL the details and submit the form below.
We will then contact you to confirm financial details to complete your application.
Or, click here to download a form which you can print and send back to us.


1. CARD TYPE
Please click on the type of fuel card you require:
CRT Card
(£6 per card per year)		 Fleet Card
(£12 per card per year)		 CRT International Card
     


2. COMPANY DETAILS
Company/Name to be embossed on all your cards
(Maximum 19 characters INC blank spaces)
Company Type
Limited Company Partnership Sole Trader Other
if 'other', please give details

Company Name     Telephone
Address 1     Mobile
Address 2     Fax
Town/City     Contact Name
County     Job Title
Postcode     Company Website
Time at this address     Email
Company Reg No. (if applic)    
We may occasionally send you information by e-mail which you may find useful. We will not pass your details to any third party. Please check the box if you DO NOT wish to be contacted via e-mail.

If not a limited company, please complete the following:

Proprietor's/Partners' Name(s)
Home Address
Postcode



It is not necessary to complete the rest of this form to apply for a euroShell CRT International Card. A separate application form will be sent to you.



3. FUEL REQUIREMENTS
Estimated Monthly Usage (by expenditure or volume)
How many petrol vehicles do you have?
How many diesel vehicles do you have?
Do you have bulk fuel delivered to your premises?
  Yes         No
Do you purchase lubricants?
  Yes         No



4. CARD DETAILS
How many cards do you require?             Do you want mileage recorded?    
  Yes         No


Please list the name of the driver and/or vehicle registration you require on each card, and indicate fuel option requirements, if known.


  Driver Name   Registration Number 1 2 3 4      Card options:
1. or  
  1. Diesel only
  2. Fuel only
  3. Fuel, Oil & Carwash
  4. Fuel, Oil, Carwash & all shop goods (excl. lottery tickets)
2. or  
3. or  
4. or  
5. or  
6. or  
7. or    
8. or    

If you require more than 8 cards, these details can be confirmed when we contact you.


5. ACCOUNT MANAGEMENT

Would you like to register for Online Account Management?   Yes      No 
Invoices are normally sent by e-mail.
If you would prefer to receive your invoice by post, please click here		  

 

6. WHERE DID YOU HEAR ABOUT INTERCITY FUELS?

 

7. TERMS AND CONDITIONS


DATA PROTECTION ACT 1998
The information which you provide may be disclosed to a licensed credit reference agency which will retain a record of the search. It may be used by other lenders in assessing applications from you and other members of your household and for occasional debt tracing and fraud protection.
  I agree to accept the InterCity Fuels terms and conditions of trading, and understand that a copy of these is available upon request
  I disagree