Gate Application Form - Excel

							United Kingdom
BP Fuel Cards Sales Team
BP Oil UK Limited
Witan Gate House
500-600 Witan Gate
Central Milton Keynes
MK9 1ES

Tel 0845 603 0723
Fax 0870 243 0077
Email
bpplus@uk.bp.com
www.bpplus.co.uk

BP PLUS Customer
application form



1 Company details

Name of Registered Company/Partnership/Sole Trader


Emboss line 2 (optional)
                                                                                (max. 27 characters)
Company address




Post Code

City / Town

Telephone                                                 Fax
Company email address


Company web page address


VAT number
Company registration number
  Please enclose latest audited accounts for credit checking purposes. Without them the application
  will not be processed. Sole traders or partnership must enclose accounts.

2 Card embossing details

Company name as it will be shown on the card (max. 27 characters)



3 Company mailing address (if different from '1' please fill here)

Invoice mailing

Address
BP PLUS Customer
application form
Post Code
City / Town

By card and PIN mailing (if different from invoice address)

Address



Post Code
City / Town

4 Not required

5 Contact person details

5.1 Main contact / Decision maker

Name
Surname
Surname


Title Mr, Mrs, Ms, etc


   Male                  Female

Job title

Telephone
Fax


Main email address (Online Services Fleet Manager)


5.2 Optional contact (eg Financial)

Name
Surname
Surname


Title Mr, Mrs, Ms, etc


   Male                  Female
Job title
Telephone
Fax
Mobile number
Main email address
BP PLUS Customer
application form
6 Fleet segmentation

  Car               Truck               Van                 Bus

  Number of Cards

  Estimated Annual Volume (Litres)
                Litres                                            Litres
  Diesel                           Motor spirit

  Estimated monthly spend (£)                                  Estimated annual spend (£)
  Total fuel                                                   Total fuel

7 Not required

8 Bank details

Please complete the enclosed Direct Debit Mandate form.
No application can be processed without this form being fully completed.

Additional information required

Nature of business


Years in business




Print name
Position
Contact telephone number                                                           Date

  Authorised signatory                                                 BP date & signature




  I/We warrant that the information supplied above is correct and I/We authorise BP Oil UK Limited and its
  representatives to contact my/our bank, or any other source, to obtain information it may require. I/We
  accept that BP Oil UK Limited reserves the right to reject this application without being required to state a
  reason. If the account is accepted, the account holder agrees to be bound by the Conditions of Use of BP
  Fuel Cards which can be found on www.bpplus.co.uk <file://www.bpplus.co.uk> or are available on request.

BP Fuel cards New Account Applications Witan Gate House 500-600 Witan
Central Milton Keynes MK9 1ES Tel: 0845 6030723 Fax: 0870 243 0077
Email: BPCardsAdmin@bp.com
www.bpplus.co.uk
BP PLUS Customer
application form
Additional information to assist form completion

1 Company details
  In this field you should fill in the company legal entity details as they will appear in the invoice.

3 Invoice mailing
  In this field you should fill the address to which you wish general correspondence and invoices to be sent.

Card and PIN mailing
  In this field you should fill the address to which you wish to receive correspondence relating to Cards
  and PIN details
  address to be sent.

5 Contact person details
  In this field please name the person who will be responsible for administering Fuel Cards in your organisation.

6 Fleet segmentation
  In this field please specify the number of each type of vehicle in your fleet.

Estimated monthly spend              BP PLUS                     Gültigkeitsbereich                 ROUTEX Logo
  Estimated monthly spend (£) is for all fuel you will purchase in a month using your fuel card(s).



Office use only

Credit Rating




Security required / Conditions




If security requested - checked                                     Signed
and validated by credit




                                                                    Date of approval