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["        单位加油IC卡主卡客户购买\n        燃油宝、汽车尾气处理液业务申请表"]
["业务类型","购买燃油宝及汽车尾气处理液"]
[]
["客户基本信息"]
["客户名称",null,"客户类型","□　储值客户\n□　记账客户","加油IC卡\n类   型","\n□ 个人多用户卡\n□ 单位单用户卡\n□单位多用户卡"]
["联 系 人",null,"证件类型","身份证","对账单\n寄送方式","\n□ 普通邮件寄送\n□ 电子邮件寄送\n□ 不寄送\n"]
["证件号码"]
["客户地址",{"$nulls":3},"邮政编码"]
["电子信箱",null,"电话号码",null,"传  真"]
["单位附加信息"]
["所属区域","  省          市/县",null,"全国组织机构代码"]
["行    业","□ 政府    □ 金融   □ 工业    □ 农业   □ 商业    □  教育    □ 医疗    □ 其它"]
["开户银行",null,"银行帐号"]
["登记注册类型",null,"工商注册号"]
["税务登记号",{"$nulls":3},"发票类型","□ 普通发票\n□ 增值税发票"]
["加油卡主卡卡号"]
["加油卡主卡卡号",{"$nulls":3},"副卡张数"]
["□ 限地区、油站：",{"$nulls":3},"□ 开通燃油宝、尾气处理液消费功能"]
["□ 设置密码"]
["兹声明：以上所填内容真实有效，同意《中国石化加油IC卡章程》的规定，现予以确认。"]
["客户签字/单位（加盖公章）：    "]
["   年     月       日"]
[]
["以下由石油公司填写"]
["客户编码",null,"主卡卡号"]
["业务流水号",null,"备注","有效期至："]
["记账客户审批"]
["第一\n责任人",null,"分公司\n零管",null,"分公司\n财务"]
["分公司\n企管",null,"分公司\n分管经理",null,"分公司\n经理"]
["受理网点：",null,"经办人：",null,null,"受理日期：      年    月  日"]