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Country

Company name or name

Street

Number

Postal code

City

Do you have a VAT or company number?

Yes

VAT number

KVK number

Other identification

Fill in your company number, national number, member ID or reference code

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First Name

Last Name

Phone number

Please enter the reference code you received from Q8 below

Code

Number of cars / motorbikes

Number of Vans (-3.5t)

Number of trucks (+3.5t), touringcars and busses

You have at least 1 car, 1 van or 1 truck

Total estimated annual volume (in liters)

This number can be changed manually if wanted to

Please enter your annual volume and not the annual number of kilometers driven

I agree with the total estimated annual volume (in liters)

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You must agree with the total estimated annual volume in order to submit your request.

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Summary of your request

Reference number

(keep this number for future reference)

Country

Company name or name

Street and number

City

VAT/Company number

KVK number

Other identification

Name

Phone number

Reference code / Group code

Number of cars / motorbikes

Number of vans (-3.5t)

Number of trucks (+3.5t), touringcars and busses

Total estimated annual volume (in liters)

In which country do you want to fill up

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Company details

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Reference code / Group code

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Your fleet (number of vehicles) ?

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