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Newline Oil Co. Ltd.

The Dirr, Murrintown, Co. Wexford Ph: 053 9139177/9139133/9139222

Old Dublin Road, Enniscorthy, Co. Wexford Ph: 053 9237233/9237330 Gorey, 053 9482211

Complete the Application Form and click submit

APPLICATION FORM (fields marked with * are required)

Saving Plan Application Form

Name

Address

Home Phone

Annual Spend on Oil (approx):

Email address

STANDING ORDER INSTRUCTION

Name/Address of Your Bank/Building Society

IBAN NO

BIC

Please charge to me/our account No

pay Allied Irish Bank, North Main Street, Wexford

(Branch No. 93-33-41) (IBAN IE16 AIBK 9333 4117 1260 79) (BIC AIBKIE2D)

for credit of the account of Newline Oil Co. Ltd. Account No. 17126079

the sum of

say _____ Euro

commencing on

and thereafter on each succeeding day of each month until further notice.

Signed

Date (today's date)