Fuel card application :

! All fields are required!

Company name

VAT

Please indicate if you are a taxpayer (Yes/No)

Yes No

Authorized Representative

Name, Surname, position

Email of the Authorized Representative:

Does this person have the right to represent the company separately? (Yes/No)

Yes No

When sending the Contract, please attach a power of attorney signed by a representative of the Company

Legal Address

Street Address

City, Municipality

Postal Code

Address

Street Address

City, Municipality

Postal Code

Contact person

Name, Surname, position

Phone

Information about the card

Card type

Circle K debit card ? Circle K credit card ? Circle K EUROPE card ?

Card user

For example, name, surname, vehicle registration number (max 27 symbols)

For what kind of goods and services are you planning to pay with this card?

Card limit EUR

Limit extra

Remove holder

Card type

Circle K debit card ? Circle K credit card ? Circle K EUROPE card ?

Card user

For example, name, surname, vehicle registration number (max 27 symbols)

For what kind of goods and services are you planning to pay with this card?

Card limit EUR

Limit extra

In order to activate your new card after receiving it, please set a PIN code for it on the Circle K self-service portal Card E-Service.

Preferred credit limit per month EUR

If contract applies to one of the credit cards

Email for sending electronic invoices

Access to the self service portal Card E-Services

A person, who is authorized to authorize on behalf of the company (access card account/s), set card PIN codes, view card transactions, block/unblock or order additional cards, change card limits, as well as add or remove users and change their access levels.

User:

Phone:

Email:

How would you like to sign and deliver the contract to Circle K?

Print out 2 copies, sign them and send them via post to the Circle K Latvia SIA office in Duntes street 6, Riga, LV – 1013 or deliver them to the nearest Circle K service station. Send it to the most convenient station for printing and signing. Please go to the station to sign the contract within 7 days from the date of the sending of the contract. Sign with an electronic signature and send to customer service email.

The service station, in which you are planning to sign the contract

By signing this Contract the Client confirms that he/she has read the SIA Circle K Latvia Company Card Terms and Conditions (version 01.05.2023., available at www.circlek.lv), agrees to them, and undertakes to comply with them. All of the information provided is true and correct.

Missing accept

Privacy notice

Circle K Privacy Statement In order for us to be able to provide the highest quality service and to be able to respond to the application in a timely manner, the information that you have submitted is being stored in our IT system. Find out more information in our Privacy Statement.