Application Form

* Required fields
20/02/2017
Commercial Customers Only
Card Details; Fuel cards accepted at BP service stations, truckstops and PLPL marina facilities. Please complete Car/Truck /Boat details for cards (you can have
as many cards as your require). If you require more room for extra card details please copy this form.
 
 
 
 
 
 
 
 
 
 
2 TRADE REFERENCES for company, (Driver licence number required for Individual below )
I certify that the above information is true and correct and that I am authorised to make this application for credit. I have read and understand the TERMS AND CONDITIONS OF TRADE (overleaf or attached) of Petroleum Logistics Pacific Limited T/A Petroleum Logistics which form part of, and are intended to be read in conjunction with this Credit Account Application and agree to be bound by these conditions. I authorise the use of my personal information as detailed in the
Privacy Act clause therein. I agree that if I am a director or a shareholder (owning at least 15% of the shares) of the Customer I shall be
personally liable for the performance of the Customer’s obligations under this contract.
*