Farmlands Fuel Card Application Form
Farmlands Fuel Card Application Form
Account Holder Details
Farmlands Account Name
Farmlands Account Number
Your Full Name
Phone Number
Email Address
Your Drivers Licence Number
Your Drivers Licence Version Number
Date of Birth
Your Residential Address
Required due to AML regulations.
Are you set up as an "Authority" on this Account?
Yes
No
Order Fuel Card
Details to appear on Card
Card Holder Name
Vehicle Registration
Are the Card Holder details identical to the Account Holder details?
Yes
No
Card Holder Details
Card Holder name
(Please ensure this matches the name on your driver’s licence)
Driver's License Number
Driver's License Version
Address
Date of Birth
Vehicle Registration
Purchase options
Please select...
All Products
All Products excl Tobacco
Diesel & Oil
Diesel Oil & DEF
Diesel Oil & Wash
Diesel Oil Wash & DEF
Diesel Only
Fuels & DEF
Fuels & Oil
Fuels Oil & DEF
Fuels Oil & LPG
Fuels Oil & Wash
Fuels Oil DEF & LPG
Fuels Oil Wash & DEF
Fuels Oil Wash & LPG
Fuels Only
Petrol & Oil
Petrol Oil & Wash
Regular & Oil
Default option is "All purchases"
Daily Dollar Limit
Please select...
No Limit
100
150
200
250
300
400
500
600
750
1,000
1,500
2,000
2,500
3,000
3,300
5,000
Default amount is $1,000
Monthly Dollar Limit
Please select...
No Limit
500
1,000
1,500
2,000
2,500
3,000
4,000
5,000
10,000
15,000
20,000
25,000
30,000
50,000
100,000
500,000
Default amount is $5,000
To activate your card you need to choose a 4-digit PIN number when you first use your card.
Change Request
Fuel Card Number
Purchase options
Please select...
All Products
All Products excl Tobacco
Diesel & Oil
Diesel Oil & DEF
Diesel Oil & Wash
Diesel Oil Wash & DEF
Diesel Only
Fuels & DEF
Fuels & Oil
Fuels Oil & DEF
Fuels Oil & LPG
Fuels Oil & Wash
Fuels Oil DEF & LPG
Fuels Oil Wash & DEF
Fuels Oil Wash & LPG
Fuels Only
Petrol & Oil
Petrol Oil & Wash
Regular & Oil
Default option is "all purchases"
Daily Dollar Limit
Please select...
No Limit
100
150
200
250
300
400
500
600
750
1,000
1,500
2,000
2,500
3,000
3,300
5,000
Default amount is $1,000
Monthly Dollar Limit
Please select...
No Limit
500
1,000
1,500
2,000
2,500
3,000
4,000
5,000
10,000
15,000
20,000
25,000
30,000
50,000
100,000
500,000
Default amount is $5,000
Reset PIN
Yes
No
You are not authorised on this account.
Please contact the Account authority to complete this request or ask the Account holder to complete the
authority form
.
I have read the
Z Business Card Terms and Conditions
and agree to abide by them.
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Contact Information
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