PETROAN

PCNGi-PETROAN CNG

PCNGi-PETROAN CNG RETAIL OUTLETS SELECTION FORM

RETAIL OUTLETS DETAILS

Company Name

CAC Number

Name of MD / Authorized Rep

Company HQ Address

L.G.A

City

State

Zip Code

Country

Contact Number

Location of retail outlets

Address 1

L.G.E.A

City

State

Zip Code

Country

Location of retail outlets

Address 2

L.G.E.A

City

State

Zip Code

Country

Location of retail outlets

Address 3

L.G.E.A

City

State

Zip Code

Country

Location of retail outlets

Address 4

L.G.E.A

City

State

Zip Code

Country

Location of retail outlets

Address 5

L.G.E.A

City

State

Zip Code

Country

DIMENSION

Space for Autogas LPG

Space for Autogas L-CNG

Space for Autogas CNG

OTHER INFORMATION

State

LGA

SALES VOLUME (PMS) QTY

Daily

Weekly

Monthly

Quarterly

Annual

SALES VOLUME (PMS) AMOUNT

Daily

Weekly

Monthly

Quarterly

Annual

Interest in setting up gas skid conversion center:

Interest in accessing FG loan for NGEP:

OTHERS (PLS SPECIFY)

DPR License:

Yes

Number of Trainees (Maximum of 5 trainees per conversion center):

Projected Cost of Installation

Loan Collateral

contacts: 08057875873, 08084875114, 08033426801, 07068082334

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PCNGi-PETROAN CNG Registration

PETROAN