WP E-Signature by Approve Me - Sign Documents Using WordPress -

CARD ORDER FORM

Company Name:

Company Address:

Attention:

Date:

Account #:

CFN Acct #:

Salesman:

Card Label (20 Characters)	Vehicle # (0-9999)	Fuel Limit Per Transaction (Vehicle Tank Size)	Product	Prompts	Number of Transactions Per Day	Hours per day	States	Store Items
					Note: Fueling outside these limits will not be allowed
		20Gallons 30Gallons 50Gallons 75Gallons 150Gallons	Diesel Reg Unl All Fuels All Products	5-Od/PIN	1 2 3	6am-6pm 6pm-6am Unlimited M-F or 7 days a week	California or List States Needed	None Oil only Scales only All Products
EXAMPLE:John Doe or vehicle	1234	30	Diesel	5-Od/PIN	2	6am-6pm M-F	California	Oil only

Protection Alert Contact Info:
(Required)

Name

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Timestamp

Audit

July 29, 2019 7:46 am PDT

CARD ORDER FORM Uploaded by RV Jensen Admin - credit@rvjensen.com IP 206.169.107.66

July 30, 2019 1:33 pm PDT

Eddie Montoya - emontoya@bctconsulting.com added by BCT Admin - bctdevelopers3@gmail.com as a CC'd Recipient Ip: 192.168.19.3

November 6, 2019 5:14 am PDT

Eddie Montoya - emontoya@bctconsulting.com added by BCT Admin - bctdevelopers3@gmail.com as a CC'd Recipient Ip: 192.168.11.66

June 23, 2020 9:30 am PDT

Credit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 206.169.107.66

June 23, 2020 11:53 pm PDT

Credit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 160.202.9.194

June 24, 2020 2:37 am PDT