| Contact Name: |
|
| Business Name: |
|
| Email: |
|
| Email (accounts/invoices): |
|
| Address: |
|
| Town: |
|
| City: |
|
| Postcode: |
|
| Postal Address (if different): |
|
| Phone: |
|
| Mobile: |
|
| Website: |
|
| |
|
| Business & Transport Information |
|
| Number of Business Vehicles OVER 3.5 Tonne: |
|
| Number of Business Vehicles UNDER 3.5 Tonne: |
|
| TSL Licence Number: |
|
| Contracted to: |
|
| |
|
| Existing Fuel Cards? |
|
| Fuel analysis to determine whether our fuel schemes will give you a higher discount? |
yes
no |
| If yes- please upload a month's fuel statement |
|
| |
|
| Discount Schemes |
|
| Are you interested in joining our fuel discount schemes? |
yes
no |
| Please select fuel card application form(s): |
Caltex
BP
Mobil
McKeown |
| Current Fuel Usage ($ or L per month): |
|
| Bridgestone Tyres application- for tyres at corporate rates? |
yes
no |
| Are you interested in JLT Insurance? |
Vehicle Insurance
Life Insurance
Business Insurance |
| |
|
| Complimentary Magazine Subscription: |
Truck and Driver |
| |
We are collecting this information so we can carry out the role as your representative body efficiently and effectively. We will hold the information at our offices at the address provided below. Individuals have the right to access and correct information we hold about them. By submitting this form you accept and agree with the terms and conditions of the NZ Trucking Association.
|
