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1Introduction
2Applicant details
3Contact details
4Other details
5Sole Trader / Partners / Directors Names & Addresses
6Trade references
7Credit requirements
8Fuel cards

Introduction

This application is for customers of Mogas Regional Pty Ltd ABN 79 111 402 110 (Mogas) who wish to establish a Credit Account for Bulk Fuel with Mogas or who wish to be issued a Mogas FuelCard. Please contact us on (08) 8367 2000 for the full Terms and Conditions relating to the supply of Products by Mogas, the use of a Credit Account or Bulk Facility and the terms of use of FuelCards issued by Mogas (Standard Terms). The Standard Terms are also available on our website (www.mogasregional.com.au).

Please note that in this Application “Terms and Conditions” means this Application, the Standard Terms and the Direct Debit Request, Direct Debit Service Agreement, Privacy Agreement and Guarantee and Indemnity set out below.

If the Applicant is a Company or an Incorporated Association, all Directors (or in the case of a sole director, all shareholders) must also complete and sign the Deed Poll of Guarantee and Indemnity.

This online form will generate a prefilled PDF for printing, signing and returning. We will also email it to the below address.