Application for a Wells Card

Green Wells Energies > Apply for Wells Energy Card

Type of Applicant / Designation

Individual

Corporate

Applicant's Name

Last Name

Company Name

ID Number

Company Registration No.

Phone/Mobile

Contact Person Name

Date of Birth

Company PIN No

Business Email

Contact Person Email

Registration Station

Postal Address

Contact Person Phone

List vehicles to be subscribed to the card

Vehicle Make	Vehicle Model	Fuel Type	Tank Capacity(ltrs)	Number Plate

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