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New Customer Registration Form
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If you are an existing customer needing Additional, Replacement or Renewal of Easy Fuel Card, you can
login
to place request or Contact our
Fleet Manager
directly.
If you're a new Customer interested in enrolling for Easy Fuel Card, please fill details in the below mentioned form.
Name of the Company
*
Contact Person's name
*
Company Address
*
State
*
Select State
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH UT
CHATTISGARH
DELHI
DN&H UT
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ORISSA
PONDY UT
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TRIPURA
UTTAR PRADESH
UTTARANCHAL
WEST BENGAL
City
*
PIN Code
Landline
(STD Code)
Phone Number
Mobile Number
*
+91
Email ID
*
Number Of Vehicles
*
Type Of Use
Request For
Request Date
All filelds marked with (
*
) are mandatory