GAS CARD CARD FORM

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GAS CARD CARD FORM Powered By Docstoc
					     PETROFLEET AUTOMATED FUELING CARD INFO
     ACCOUNT #

     Customer Name:

     Address:


                                            DRIVER INFO                                                                                                                               VEHICLE INFO
                                                                                                                                                   UNATTENDED SITE FEATURES                                          EXPANDED VOYAGER LOCATIONS
                                                                                                                                    Vehicle Description or Driver




                                                                                                                                                                                                          Odometer
                                                                          Restrict        Unit # or                                             Name
                                                                                                                                                                                                                     Expanded
                                                                          driver to   description of                                  This information will be                        Type(s) Of Fuel
                                                                                                                                                                  Max # Max #                                        Network?     Max.       Max      Max
                                                                Pin # Up vehicle Y     vehicle to be                                 imprinted on card You can
                                                                                                                                                                  Trans/ Trans/                                      (Voyager)   Dollars/   Swipes/   Swipes/
                                                                                                                                       use up to 17 characters
          First Name                   Last Name               to 5digits   or N    restricted to driver Hours To Fuel Days To Fuel                               Day    Month                                         Yor N      Month      Day      Month
                                                                                                        7am-6pm___     M-F_____                                                   HWY DSL______
                                                                                                        8am-5pm___     M-S ____                                                   Unlead _____
                                                                                                        24Hrs____      ALL____                                                    Unleads(87)(89)(93)__
1                                                                                                       _________      _________                                                  Off RD Dsl ______        X
                                                                                                        7am-6pm___     M-F_____                                                   HWY DSL______
                                                                                                        8am-5pm___     M-S ____                                                   Unlead _____
                                                                                                        24Hrs____      ALL____                                                    Unleads(87)(89)(93)__
2                                                                                                       _________      _________                                                  Off RD Dsl ______        X
                                                                                                        7am-6pm___     M-F_____                                                   HWY DSL______
                                                                                                        8am-5pm___     M-S ____                                                   Unlead _____
                                                                                                        24Hrs____      ALL____                                                    Unleads(87)(89)(93)__
3                                                                                                       _________      _________                                                  Off RD Dsl ______        X
                                                                                                        7am-6pm___     M-F_____                                                   HWY DSL______
                                                                                                        8am-5pm___     M-S ____                                                   Unlead _____
                                                                                                        24Hrs____      ALL____                                                    Unleads(87)(89)(93)__
4                                                                                                       _________      _________                                                  Off RD Dsl ______        X
                                                                                                        7am-6pm___     M-F_____                                                   HWY DSL______
                                                                                                        8am-5pm___     M-S ____                                                   Unlead _____
                                                                                                        24Hrs____      ALL____                                                    Unleads(87)(89)(93)__
5                                                                                                       _________      _________                                                  Off RD Dsl ______        X
                                                                                                        7am-6pm___     M-F_____                                                   HWY DSL______
                                                                                                        8am-5pm___     M-S ____                                                   Unlead _____
                                                                                                        24Hrs____      ALL____                                                    Unleads(87)(89)(93)__
6                                                                                                       _________      _________                                                  Off RD Dsl ______        X
                                                                                                        7am-6pm___     M-F_____                                                   HWY DSL______
                                                                                                        8am-5pm___     M-S ____                                                   Unlead _____
                                                                                                        24Hrs____      ALL____                                                    Unleads(87)(89)(93)__
7                                                                                                       _________      _________                                                  Off RD Dsl ______        X
                                                                                                        7am-6pm___     M-F_____                                                   HWY DSL______
                                                                                                        8am-5pm___     M-S ____                                                   Unlead _____
                                                                                                        24Hrs____      ALL____                                                    Unleads(87)(89)(93)__
8                                                                                                       _________      _________                                                  Off RD Dsl ______        X
                                                                                                        7am-6pm___     M-F_____                                                   HWY DSL______
                                                                                                        8am-5pm___     M-S ____                                                   Unlead _____
                                                                                                        24Hrs____      ALL____                                                    Unleads(87)(89)(93)__
9                                                                                                       _________      _________                                                  Off RD Dsl ______        X
                                                                                                        7am-6pm___     M-F_____                                                   HWY DSL______
                                                                                                        8am-5pm___     M-S ____                                                   Unlead _____
                                                                                                        24Hrs____      ALL____                                                    Unleads(87)(89)(93)__
10                                                                                                      _________      _________                                                  Off RD Dsl ______        X

     Fuel type, time of day and days to fuel are not features at expanded voyager retail locations.                                                     Date :                                                       PETROFLEET FAX:666-6016
     Restrictions may not function properly at certain unattended locations due
      to some fuel dispensers or card reader equipment.                                                                                           Signature:                                                                     Page______of ________

				
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