COMMERCIAL FUELS ORDER FORM Status *   New Customer       Existing Customer  Account No Contact Name * Select..Mr.Mrs.M/sDr.Rev. First Name: * Last Name: * Company or Business Name Contact Details Valid Email Address * Telephone No: * Phone Type:   Home       Work       Mobile  Telephone No: Phone Type:   Home       Work       Mobile  Delivery Details Is Address the Invoice Address? *   Yes       No  Street Number * Street Address * Street Address (Cont'd) Town * Postcode   * County * Select County...BedfordCambsEssexHertsKentNorfolkSuffolkSussex Invoice to Name & Address (If Different) Specific Delivery Instructions Product Required Product * Select Product....Farm DieselDieselGas OilGasolineHeating OilKeroseneULSD Quantity  * Preferred Delivery *     dd/mm/yyyy Alternative Delivery *     dd/mm/yyyy Payment Method * Select Payment method...Bankers DraftCashChequeCredit Card.Debit Card.Direct Debit Please note our standard terms of payment are payment on or before delivery. By pressing the "Order Now" Button you are agreeing to our terms and conditions. PRIVACY POLICY CPS Fuels is committed to protecting your privacy and security. We will only use the information we collect about you with your consent to tell you about our services & special offers. We will never wilfully disclose personal data about you to any third party without first receiving your permission or unless we are under a legal obligation to do so. * = Input is required

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