APPLICATION FORM FOR APIOS A-CARD BONUS CARD APIOS A-CARD BONUS CARD A-CARD BONUS CARD (hereinafter: the Card) is intended for legal entities, family farms and crafts. The Card shall not be a mean of payment. When paying by cash or bank card at APIOS’ point of sale, the Card User (hereinafter: the User) shall be granted discounts defined by APIOS. AAPIOS shall be fully authorized to entirely autonomously define the duration of the discount, the discounted items and the discount amount. APIOS shall be fully autonomously authorized to designate the Card User. APIOS shall be fully autonomously authorized to, without explanation and/or liability, inform the Card User on the termination of the validity of the Card. After the completed Application is reviewed and approved, the User shall receive the Card he/she/it personally takes over at the petrol station that he/she/it has indicated on the Application. The Card shall be the property of APIOS, issued to a specific person and cannot be transferred to third persons. If the personal data on the basis of which the Card was issued and which are noted in the Application are changed, the User shall be obliged to inform APIOS in writing by e-mail: firstname.lastname@example.org, or by completing an Application at an APIOS petrol station. In the case of theft or loss of the Card, Article 5.10. of these General Terms and Conditions shall apply. The User shall be fully responsible for the misuse of the Card. If the User cancels the use of the Card, he/she/it shall be obliged to inform APIOS of it in writing, by e-mail: email@example.com, and return the Card to APIOS’ address. APPLICATION FORM FOR APIOS A-CARD BONUS CARD Fill in*New cardChange data on card number*CARD NUMBER**NAME**SURNAME*ADDRESS**STREET AND HOUSE NUMBER*ZIP CODE*CITY *COMPANY NAME**PIN*LICENSE PLATES*MOBILE PHONE NUMBER**E-MAIL* *FUEL TYPE* A-MOTION EUROSUPER 95 BS A-MOTION EUROSUPER 100 BS A-MOTION EURODIESEL BS EURODIESEL BS PLAVI LPG AD BLUE EURO LUEL *ESTIMATED FUEL PURCHASE PER MONTH**Name of the APIOS petrol station at which you would like to pick up your card:*BISTRACABUNAČAKOVECDUGOPOLJEKANFANARKARLOVACKAŠTEL ŠTAFILIĆKONJŠČINAKOPRIVNICAKRIŽMEDULINPETRINJAPRIGORJE BRDOVEČKOPULARUGVICASLAVONSKI BRODSESVETESOPVIROVITICAZADARZADAR TROMILJAZADAR ŽMIRIĆIUMAGVARAŽDINDATE AND PLACEData selected with star * is necessary and unfilled Application forms shall not be used in consideration.NOTES:I confirm that I am familiar with and agree with the General Terms and Conditions for the Use of the Card* General Terms and Conditions For all questions or help regarding fulfilment of the Application forms please be free to contact A-CARD department on 0800 5771 or firstname.lastname@example.org.