Rebrand yourfuel station,

Full name

Contact no

Email address

Erf/Stand no

Street/road name

Area

Nearest city/town

Province —Please choose an option—Eastern CapeFree StateGautengKwaZulu-NatalLimpopoMpumalangaNorth WestNorthern CapeWestern Cape

ULP 95 (litres per month)

ULP 93 (litres per month)

Diesel 50ppm (litres per month)

Diesel 10ppm (litres per month)

Do you have a retail licence issued by the Department of Energy? —Please choose an option—YesNo

Are the forecourt and buildings in fairly good condition? —Please choose an option—YesNo

Monthly turnover

Is another oil company currently involved with the station? —Please choose an option—YesNo

If yes, which company?

Is there a convenience store? —Please choose an option—YesNo