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CARD ACCOUNT
APPLICATION

V1: 01.09.2021
Contact Details

Name of main contact for the account

Position
E-mail
Cell number
Office number
Requires an e-mail for each transaction on the Yes / No
account? Yes
Receives statements Yes / No
Yes
Requires a low balance warning when funds on Yes / No
Yes
the account are low?

Name of additional contact for the account

Position
E-mail
Cell number
Office number
Requires an e-mail for each transaction on the Yes / No
Yes
account?
Receives statements Yes / No
Yes
Requires a low balance warning when funds on Yes / No Yes
the account are low?

Name of additional contact for the account

Position
E-mail
Cell number
Office number
Requires an e-mail for each transaction on the Yes / No Yes
account?
Receives statements Yes / No
Yes
Requires a low balance warning when funds on Yes / No
Yes
the account are low?
Card Details

Name on Card Card 1 Card 2 Card 3 For Example

• Make of Vehicle and
Colour White Toyota
• Vehicle Registration No? Hilux
• Miscellaneous – for NH****
containers etc.

Tank Capacity Limitation? Y/N?

If YES, tank capacity limit in litres

Pin Required for Card? Y/N?

If YES, PIN Number for each Card?

Capture Odometer at time of sale? Yes / No Yes / No Yes / No

Yes Yes Yes
Capture Order No. at time of Sale? Yes / No Yes / No Yes / No
No No No
Print Balance on Receipt? Yes / No Yes / No Yes / No
No No No
SMS notification for each sale? Yes / No Yes / No Yes / No
Yes Yes Yes
Cel Number for SMS’s

Which days of the week can the Any day Any day Any day
card be used? Mon, Tue, Wed, Mon, Tue, Wed, Mon, Tue, Wed,
Please circle correct option. Thu, Fri, Sat, Sun Thu, Fri, Sat, Sun Thu, Fri, Sat, Sun

Any time Any time Any time

What times can the card be used? 04h00 – 22h00 04h00 – 22h00 04h00 – 22h00
Please circle correct option. 07h00 – 19h00 07h00 – 19h00 07h00 – 19h00
08h00 – 17h00 08h00 – 17h00 08h00 – 17h00
06h00 – 18h00 06h00 – 18h00 06h00 – 18h00

Name on Card Card 4 Card 5 Card 6 Card 7

• Make of Vehicle and
Colour
• Vehicle Registration No?
• Miscellaneous – for
containers etc.

Tank Capacity Limitation? Y/N?

If YES, tank capacity limit in litres

Pin Required for Card? Y/N?

If YES, PIN Number for each Card?

Capture Odometer at time of sale? Yes / No Yes / No Yes / No Yes / No

Yes Yes Yes Yes
Capture Order No. at time of Sale? Yes / No Yes / No Yes / No Yes / No
No No No No
 Print Balance on Receipt? Yes / No Yes / No Yes / No Yes / No
No No No No
SMS notification for each sale? Yes / No Yes / No Yes / No Yes / No
Yes Yes Yes Yes
Cel Number for SMS’s

Which days of the week can the Any day Any day Any day Any day
card be used? Mon, Tue, Wed, Mon, Tue, Wed, Mon, Tue, Wed, Mon, Tue, Wed,
Please circle correct option. Thu, Fri, Sat, Sun Thu, Fri, Sat, Sun Thu, Fri, Sat, Sun Thu, Fri, Sat, Sun

Any time Any time Any time Any time

What times can the card be used? 04h00 – 22h00 04h00 – 22h00 04h00 – 22h00 04h00 – 22h00
Please circle correct option. 07h00 – 19h00 07h00 – 19h00 07h00 – 19h00 07h00 – 19h00
08h00 – 17h00 08h00 – 17h00 08h00 – 17h00 08h00 – 17h00
06h00 – 18h00 06h00 – 18h00 06h00 – 18h00 06h00 – 18h00

Online Fuel Account Access (Optional)

Complete this form if you would like online access to your fuel account and would like to view
statements and receipts.

Name of main person with access to the online

portal
Position
E-mail
Cell number
Identity Number
Username:
The Username field must be at least 4 characters in length.
Password:
The Password field must be at least 8 characters in length.
Password must contain numbers. (i.e. - F+Tg4y&3). Space
counts as a special character.

V+ Registration Card Details

Complete this form if you would like to take part in the V+ Rewards Programme.

Name of main contact for the account

Position
Gender
E-mail
Cell Number
Identity Number
Set Secret Pin No (4 numerical digits)
Existing Card No (if already registered)