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WHAT TYPE OF CUSTOMER ARE YOU ?
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Cardholder Name
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Mobile Number
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Enter phone number in (0751xxxxxx) format
Email Address
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Vehicle Registration
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ID Type
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National Id
Passport
ID/Passport No
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Diesel
Petrol
Stabex Gas
Regions of Operation
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Central
Western
Northern
Eastern
Albertain
Pick up Location
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Central
Western
Eastern
Northern
Albertain
Central
Stabex Nansana
Stabex Buloba
Stabex Namataba
Western
Stabex Mbarara
Stabex Ruti
Eastern
Stabex Amber
Stabex Wanyange
Northern
Stabex Agwen
Stabex Arua
Albertain
Stabex Bukwiri
Stabex City Fuel
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Cardholder Name
*
To be imprinted on card
Mobile Number
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Enter phone number in (0751xxxxxx) format
Company Name
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To be imprinted on card if different from above
Company Registration No.
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Provide a valid company registration number
Email Address
*
Provide an active email address
Vehicle Registration
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Choose your product restriction
*
Diesel
Petrol
Stabex Gas
Regions of Operation
*
Central
Western
Northern
Eastern
Albertain
Preferred Pick Up Location
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Select Region
Central Region
Western Region
Eastern Region
Northern Region
Albertian Region
Central Region
Stabex Nansana
Stabex Nsangi
Stabex Namasuba
Western Region
Stabex Mbarara
Stabex Ruti
Eastern Region
Stabex Jinja
Stabex Iganga
Northern Region
Stabex Arua
Stabex Lira
Albertain Region
Stabex Kiboga
Stabex Hoima
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