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POSTPAID ENERGY PLUS APPLICATION
POSTPAID ENERGY PLUS
All APPLICABLE SECTIONS MUST BE COMPLETED
VANDDIS ENERGY POSTPAID PLUS
First Name
(Required)
Last Name
(Required)
I.D. Number
(Required)
Phone Number
(Required)
Company Name
Address
(Required)
Email
(Required)
Credit Information
Guarantee:
Deposit
Bank credit reference
Est. Monthly Purchase :
(Required)
Naƒ.
Deposit :
Naƒ.
Bank Credit Reference
Bank :
Contact Person :
Vehicles Information
Quantity Of Vehicles
1
2
3
4
5
6
7
8
9
10
Quantity
(Required)
Brand
(Required)
Model
(Required)
Fuel Type
(Required)
Gasoline
Diesel
Quantity
(Required)
Brand (2)
(Required)
Model
(Required)
Fuel Type
(Required)
Gasoline
Diesel
Quantity
(Required)
Brand (3)
(Required)
Model
(Required)
Fuel Type
(Required)
Gasoline
Diesel
Quantity
(Required)
Brand (4)
(Required)
Model
(Required)
Fuel Type
(Required)
Gasoline
Diesel
Quantity
(Required)
Brand (5)
(Required)
Model
(Required)
Fuel Type
(Required)
Gasoline
Diesel
Quantity
(Required)
Brand (6)
(Required)
Model
(Required)
Fuel Type
(Required)
Gasoline
Diesel
Quantity
(Required)
Brand (7)
(Required)
Model
(Required)
Fuel Type
(Required)
Gasoline
Diesel
Quantity
(Required)
Brand (8)
(Required)
Model
(Required)
Fuel Type
(Required)
Gasoline
Diesel
Quantity
(Required)
Brand (9)
(Required)
Model
(Required)
Fuel Type
(Required)
Gasoline
Diesel
Quantity
(Required)
Brand (10)
(Required)
Model
(Required)
Fuel Type
(Required)
Gasoline
Diesel
Signature and Customer Agreement
Everything I have stated in this application is correct to the best of my knowledge. VANDDIS is given permission to verify the information stated on this application. This application is property of VANDDIS B.V.
Signature of Applicant
Hidden
Date of Application
MM slash DD slash YYYY
I have read and agree to the Terms & Conditions and Additional Disclosures.
(Required)
I have read and agree to the
Terms & Conditions
and Additional Disclosures.
(Required)
→
Contact Us
Contact Form
- Select -
Sales
Support
Custom File Upload
Phone
+599 9 724 1459
Super
Super: XCG 1.866/Ltr
Diesel
Diesel: XCG 1.593/Ltr
Gas
Gas Chiki: XCG 16.00
Prepaid
Apply for a Prepaid Card
Postpaid
Apply for a Postpaid Card