Event Fuel Purchase Order Form

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2009 FIA WORLD RALLY CHAMPIONSHIP Event Fuel Purchase Order Form Price per litre € 4.56 (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 €’s. American Express is not accepted! Please tick to specify fuel type: Gasoline Diesel Rally Event 25 Litre Cans Fuel dispensed Total Litres collected from fuel truck into rally cars Team Driver(s) Entry No(s) Contact Person Telephone No. Mobile No. Fax No. Contact Details E-mail Address Final Dates for Fuel Orders Rally Ireland 07/01/09 Acropolis Rally 20/05/09 Rally Norway 21/01/09 Rally Poland 03/06/09 The Cyprus Rally 18/02/09 Rally Finland 08/07/09 Rally de Portugal 11/03/09 Rally Australia 29/07/09 Rally Argentina 18/03/09 Rally de Espana 09/09/09 Rally d’Italia-Sardegna 29/04/09 Wales Rally GB 30/09/09 FUEL WILL BE AVAILABLE THE DAY BEFORE SCRUTINEERING Please return this order to [email protected] Page 1 of 2 Or fax by 00 44 1981 241169 2009 FIA WORLD RALLY CHAMPIONSHIP Company Name Address (Street / Postal Code / City) Country Invoice Details Details Invoice VAT Registration Owner of Account 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 Pre-Payment to to Pre-Payment Purchase Order No Credit/Debit Card Details Card Type Card Number Valid From Expiry Date Card Holders Name Card Holder Address (Street / Postal Code / City / Country) Issue Number Security Code I hereby give permission to keep my credit card details on file Print Name Signature Details will be kept until the 31ST October 2009. FUEL WILL BE AVAILABLE THE DAY BEFORE SCRUTINEERING Please return this order to [email protected] Page 2 of 2 Or fax by 00 44 1981 241169 .

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