prepaid energy card - VANDDIS

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Services
Energy Card
Energy Plus
Energy Truck
About us
Locations
Contact
APP LOGIN

Home
Services
Energy Card
Energy Plus
Energy Truck
About us
Locations
Contact
APP LOGIN

Home
Services
Energy Card
Energy Plus
Energy Truck
About us
Locations
Contact
APP LOGIN

prepaid-energy-card

PREPAID ENERGY CARD
All APPLICABLE SECTIONS MUST BE COMPLETED

Applicant Information

First Name:(Required)

Last Name:(Required)

Company Name:

Address:(Required)

I.D. Number:(Required)

Telephone:(Required)

Cell Phone:

Email:(Required)

Card Information

This option grants authorization for card to be used to pay for all services offered at Vanddis Station

Debit Permitted:(Required)

Yes

No

Number of cards desired:

Card Identification(Required)

Plate Number(s) or Driver Name(s)

Card Identification (2)(Required)

Plate Number(s) or Driver Name(s)

Card Identification (3)(Required)

Plate Number(s) or Driver Name(s)

Card Identification (4)(Required)

Plate Number(s) or Driver Name(s)

Card Identification (5)(Required)

Plate Number(s) or Driver Name(s)

Card Identification (6)(Required)

Plate Number(s) or Driver Name(s)

Card Identification (7)(Required)

Plate Number(s) or Driver Name(s)

Card Identification (8)(Required)

Plate Number(s) or Driver Name(s)

Card Identification (9)(Required)

Plate Number(s) or Driver Name(s)

Card Identification (10)(Required)

Plate Number(s) or Driver Name(s)

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.

I have read and agree to the Terms & Conditions and Additional Disclosures.

Signature of Applicant(Required)

Hidden

Date

MM slash DD slash YYYY

Terms & Conditions

(Required)

I agree to the terms & conditions.(Required)

About us

Our commitment is to make your trip to the gas station easy and enjoyable. Vanddis is ready to serve you 24/7 throughout the whole year.

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Contact info

Schottegatweg Noord # 6
+599 9 724 1459
info@vanddis.com

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Diesel - XCG 1.645/L
Super - XCG 1.913/L
Gas Chiki - XCG 16.00
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