I, the applicant, being the occupier of the premises detailed in the following Schedule, comprising wholly or partly a 'petroleum filling station', hereby apply for a licence to keep the following fuels:

By clicking agree, you declare that the following Schedule contains a full and true statement of the particulars set forth. In the event of a licence being granted, you agree to abide by the conditions laid down by the West Midlands Fire Authority, and not to alter in any way the Approved Arrangements of the premises without the prior written approval of the licensing authority, nor use the said premises for any other purpose than those prevailing at the time the licence is granted.