Customer Request Form
Customer Request Form
Customer Request Form
1) Please complete the form in BLOCK LETTERS. All personal particulars are necessary for us to process your requests. For lost/stolen/faulty cards,
2) Fax the form to us at 03-2161 8233, email to [email protected] or drop it at any Petron, Esso or Mobil service stations. please call the Petron Miles
3) For more information, please call the Petron Miles Customer Service Centre at 1 300 888 812. Hotline immediately to
block the card.
(A) New Registration/Change of Details (B) Retro Claim (C) Points Transfer
Address*
(Malaysia Address Only)
State
Total Purchase: RM
✃ (Please detach)