CARD ORDER FORM


CARD ORDER FORM

 
 
  Note: Fueling outside these limits will not be allowed  
Card #
(Office Use Only)
Card Label
(20 Characters)
Vehicle #
(0-9999)
Fuel Limit
Per Transaction
(Vehicle Tank Size)
ProductPromptsNumber of
Transactions
Per Day
Hours per
day
StatesStore
Items

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)

Leave this empty:

Signature arrow

Signature Certificate
Document name: CARD ORDER FORM
lock iconUnique Document ID: 0fe82c6ca2962b414833973d65cd8cd9ee16f7df
Timestamp Audit
July 29, 2019 7:46 am PSTCARD ORDER FORM Uploaded by RV Jensen Admin - credit@rvjensen.com IP 206.169.107.66
July 30, 2019 1:33 pm PSTEddie 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 PSTEddie 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 PSTCredit 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 PSTCredit 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 PSTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 4:19 am PSTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 4:20 am PSTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 4:23 am PSTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 4:38 am PSTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 5:54 am PSTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 5:57 am PSTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 29, 2020 2:27 pm PSTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 206.169.107.66