Saving Plan Application Form

Newline Oil Co. Ltd - Circle K

Your Name*

Your Address*

Home Phone*

Mobile*

Annual Spend on Oil (approx)

House Owner or Rented

Email*

Standing Order Instruction

Name of Your Bank/Building Society*

Address of Your Bank/Building Society*

IBAN No

BIC

Please charge to me/our account No*: and pay Allied Irish Bank, North Main Street, Wexford (Branch No. 93-33-41) (IBAN: IE16 AIBK 9333 4117 1260 79) (BIC AIBKIE2D) for the credit of the account of Newline Oil Co. Ltd. Account NUmber. 17126079 the sum of say Euro, commencing on and thereafter on each succeeding day of each month until further notice.

Signed:
Date:

Instructions to your Bank or Building Society
1. I instruct you to pay standing order from my account at the request of Newline Oil Co. Ltd.
2. The amounts are fixed and will be debited on a fixed date.
3. I understand that Newline Oil Co. Ltd. may change the amounts and dates only after giving me prior notice.
4. I will inform the bank/building society in writing if I wish to change this instruction.
5. I understand that if any standing order is paid which breaks the terms of this instruction the bank/building society will make a refund.