Account Application

Business Name *

Business Type *

Ltd Company

Individual

Sole Trader

Partnership

Other

Other Business Type (if selected above)

Trading as

Postal Address *

Contact Information

Applicant's Name *

Mobile *

Telephone *

Email *

Position *

Business Details

Nature of Business *

New Zealand Business Number / Company Number *

Years in Business *

Estimated Annual Fuel Usage (in litres) *

Which Gull site/sites will you predominantly use? *

Certification

I hereby certify that the above information is to the best of my knowledge and belief, true and correct; and that I am duly authorised to make this account application on behalf of the applicant. *

Business Name *