Survey Customers APW

1
Company Name:
2
utm_source
3
utm_medium
4
utm_campaign
5
Your Name* This field is required.
First Name
Last Name
6
Email* This field is required.
example@example.com
7
Phone Number* This field is required.
8
Company Name* This field is required.
9
Location* This field is required.
10
Industry* This field is required.
Please Select
Please Select
Mining
Transport
Excavation
Construction
Other
11
Please specify your industry:
12
Average Weekly Fuel Consumption (Litres)* This field is required.
13
Current Refueling Model
Tank on-site
Petrol Station
Mobile refuelling
14
Do you own the tank?
YESNO
15
Who currently supplies the tank?
16
Do you use a fuel card?
YESNO
17
Do you have a negotiated fuel price? Please describe.
18
Please describe your current refuelling process and pricing model. (e.g., fixed price per litre, daily rate, etc.)
19
Current Fuel Supplier (if any):If you prefer to not say, just leave in blank.
20
What are your primary challenges related to fuel management? (e.g., cost fluctuations, supply issues, administrative burden)
21
Do you experience seasonal fluctuations in fuel usage?
22
Who currently supplies the tank?
23
GOOGLE ANALYTICS
Should be Empty: