2012 FIA WORLD RALLY CHAMPIONSHIP Event Fuel Purchase Form Price per litre €4.90 (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 either by bank transfer or credit card and accepted in EUROs only. 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) : Competition No(s) : Contact Details Contact Person : Phone : Mobile : Fax : Email : Final Dates for Fuel Orders Rally Monte Carlo : 28/12/2011 Rally Greece: 02/05/2012 Rally France : 12/09/2012 Rally Sweden : 18/01/2012 Rally New Zealand : 16/05/2012 Rally Italy : 26/09/2012 Rally Mexico : 01/02/2012 Rally Finland : 11/07/2012 Rally Spain : 17/10/2012 Rally Portugal : 07/03/2012 Rally Germany : 01/08/2012 Rally Argentina : 21/03/2012 Rally GB : 22/08/2012 FUEL WILL BE AVAILABLE THE DAY BEFORE SCRUTINEERING Please return this form to [email protected] Fax: 00 44 1981 241169 Page 1 of 2 2012 FIA WORLD RALLY CHAMPIONSHIP Invoice Details Company Name : Street : City : Postcode : Country : VAT Registration : Payment Type : Bank Transfer : Credit Card : Bank Transfer 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 on file Details will be kept until 30 November 2012 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.