2010 FIA WORLD RALLY CHAMPIONSHIP Event Fuel Purchase Form

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2010 FIA WORLD RALLY CHAMPIONSHIP Event Fuel Purchase Form 2010 FIA WORLD RALLY CHAMPIONSHIP Event Fuel Purchase Form Price per litre €4.63 (including all taxes) Deadlines for order: European events - 3 weeks before shakedown Long haul events - 5 weeks before shakedown. After deadlines we cannot guarantee additional orders Please note that payment must be received in full, one week before shakedown. Payments can only be accepted in EUROs. American Express is not accepted! Please tick to specify fuel type : Gasoline: Diesel: Rally Event : 25 Litre Cans : Fuel Dispensed : collected from fuel truck into rally cars Total Litres : Team : Driver(s) : Entry No(s) : Contact Details Contact Person : Phone : Mobile : Fax : Email : Final Dates for Fuel Orders Rally Sweden : 20/01/2010 Rally Portugal : 05/05/2010 Rally Japan : 04/08/2010 Rally Mexico : 27/01/2010 Rally Bulgaria : 16/06/2010 Rally of France : 08/09/2010 Rally Jordan : 23/02/2010 Rally Finland : 07/07/2010 Rally Spain : 29/09/2010 Rally Turkey : 24/03/2010 Rally Germany : 28/07/2010 Rally GB : 20/10/2010 Rally New Zealand : 31/03/2010 FUEL WILL BE AVAILABLE THE DAY BEFORE SCRUTINEERING Please return this form to [email protected] Fax: 00 44 1981 241169 Page 1 of 2 2010 FIA WORLD RALLY CHAMPIONSHIP Invoice Details Company Name : Street : City : Postcode : Country : VAT Registration : Pre-Payment to : Account Owner : Petrochem Carless Ltd re World Rally Deposit Bank : Lloyds TSB Bank Code : 30-00-09 Account No : 86350201 IBAN Code : GB 94 LOYD 3000 0986 3502 01 Swift Code : LOYDGB21013 Purchase Order No : Credit Card Details Card Type : Card Number : Security Code : Issue No : Valid From : Expiry Date : Card Holder’s Name : Street : City : Postcode : Country : I hereby give permission to keep my credit card details of file Details will be kept until 31 October 2009 Print Name : Signature : FUEL WILL BE AVAILABLE THE DAY BEFORE SCRUTINEERING Please return this form to [email protected] Fax: 00 44 1981 241169 Page 2 of 2.
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