PETROAN Membership Form

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Step 1 of 6

Company Name

CAC Number

RC:

Name of MD/Authorized Rep.

First

Last

Office Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Contact Phone Number

E-mail

Website / URL

Location of Filling Stations

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Main Business Interest

Number of filling Stations

Locations Other Filling Stations

Address 1

Address Line 1

City

State / Province / Region

Postal Code

Country

Address 2

Address Line 1

City

State / Province / Region

Postal Code

Country

Address 3

Address Line 1

City

State / Province / Region

Postal Code

Country

Address 4

Address Line 1

City

State / Province / Region

Postal Code

Country

Address 5

Address Line 1

City

State / Province / Region

Postal Code

Country

Address 6

Address Line 1

City

State / Province / Region

Postal Code

Country

Address 7

Address Line 1

City

State / Province / Region

Postal Code

Country

Address 8

Address Line 1

City

State / Province / Region

Postal Code

Country

Address 9

Address Line 1

City

State / Province / Region

Postal Code

Country

Address 10

Address Line 1

City

State / Province / Region

Postal Code

Country

Number of Employee

PETROAN Membership Form

Locations Other Filling Stations

Station Lessee as a Member shall provide the following;

Notice to all Members

The legitimacy of such an agreement in writing. This membership category shall not contest for any elective position but can be an appointment