中国石化加油IC卡客户业务申请表

Application Form for Customer Business

□客户开户 Customers open accounts

业务类型Business type

□客户资料变更 The material of the customer is increasing further more□不记名转记名 Unregistered cards record key points of interest□客户清户 Customers cancel accounts

客户姓名Name of thecustomer

省（市）

所属区域 District

Province (city)市/区/县

City/district/county

联系人Linkman证件号码Certificate No.客户地址Addressof the customer

电子邮件E-mail开户银行Bank of deposit

移动电话Mobile phone

银行帐号Bank account

加油限制信息（选填）Information of refueling limit（choices）

□限车号 Limited car numbers:

□限地区油站 Limited areas and gas stations:

□限每天加油次数 Limited refueling times per day: ( )次 time(s)□限每天加油金额 Limited refueling sum per day: ( )元 yuan□限每次加油量 Limited fueling charge of each time: ( )升 liter(s)□限油品 Limited oil products：

兹声明：以上所填内容真实有效，同意背面《中国石化加油IC卡章程》的规定，现予以确认。

In Witness Where of, the following content is real and effective; the user agrees to abide by the regulations of the “Articles of the Refueling ICCard of SINOPEC” and herein confirms it.

证件类型Certificate type

邮政编码Zip code传真Fax

已持卡量Number of thecards held

客户类型Customer type

□单位单用户卡

Single user’s card of the unit□单位多用户卡

Multi-user’s card of the unit□个人单用户卡

Single user’s card of the individual□个人多用户卡

Multi-user’s card of the individual

客户签字/单位（加盖公章）Signature of the customer/unit（official seal）

（ ）日 day of（ ）月 month,20（ ）年 year

以下由发卡公司填写 The following shall be filled in by the card-issuing company

客户编码Customer No

持卡（联系）人姓名 Name of the card holder（linkman）：

主卡卡号 Master card No卡有效期

Term of validity of the card：

备注 Remarks

操作员 Operator：

日期 Date: