| Your Contact Details 
 Name:*
 
 
 Position:
 
 
 Address:
 
 
 Tel:*
 
 
 Mobile:
 
 
 Email:*
 
 
 
 
 
 | I would like to receive further information on becoming part of the solo Retail
                network 
 Current site address*
 
 
 Current brand (if any):
 
 
 Is the site:
 
 Weekly Literage:
 Derv
                
                     Petrol
 
 Tank sizes:
 Derv
                
                     Petrol
 
 Does the site have a shop?
 
 If so what is the brand name?
 
 
 
 
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