Registration Successful

CAC Number*

Company Name*

First Name*

Last Name*

Country*

Contact Number*

website

LGA*

Address*

Main Business Interest*

Other Business interest

Number of Employee*

Click as Applicable*

Owners oflicensed/Petroleum Products Retail Stations Owners of other Government approved Petroleum Selling Outlets Government Licensed individual/Company Petroleum Storage inthe Nation

Lessee as a Member

Leased/licensed Petroleum products Station

Cert. of incorporation *

Article and Memo*

DPR License of theStation*

Picture of the Station*

Passport Pictures of the registering member*