Apply for EV Chargepass

Which EV fuel card do you want to apply for?*

Shell Recharge

Mina Chargepass®

Has one of our team been helping you?*

What type of company are you?*

Sole Trader

Limited Company

Partnership

Other Business Type

Type of Business*

If Other...

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How many company partners are there?*

Company Name*

Company Registration Number*

Company Address*

Street Address Address Line 2 City ZIP / Postal Code

Trading Address*

Street Address Address Line 2 City ZIP / Postal Code

Your Details

Your Position

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First Name*

Surname*

Date of Birth*

Email Address*

Contact Number*

Your home address*

Street Address Address Line 2 City ZIP / Postal Code

How long have you lived at this home address?*

Your previous home address*

Street Address Address Line 2 City ZIP / Postal Code

Please list the Title, Full Names, D.O.B and Home Addresses for the other partners*

How many electric vehicles do you currently have?

Please provide the details for drivers and vehicles for each card you would like*

Bank Name*

Bank Address

Bank Account Number*

Bank Sortcode*

Name on account*

The Direct Debit Guarantee

Originators Identification Number 538610.

This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits

If an error is made in the payment of your Direct Debit, by Fleetmaxx Solutions LTD or your Bank or Building Society, you are entitled to a full and immediate refund of the amount paid from your bank or building society - if you receive a refund you are not entitled to, you must pay it back when Fleetmaxx Solutions LTD ask you to.

You can cancel a Direct Debit at any time by simply contacting your Bank or Building Society. Written confirmation may be required. Please also notify us.

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POWER UP YOUR JOURNEY

APPLY FOR EV CHARGEPASS

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The Direct Debit Guarantee

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