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)
Product Prompts Number of
Transactions
Per Day
Hours per
day
States Store
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:

Robert V. Jensen, Inc https://rvjensen.com
Signature Certificate
Document name: CARD ORDER FORM
Unique Document ID: 0fe82c6ca2962b414833973d65cd8cd9ee16f7df
Timestamp Audit
July 29, 2019 7:46 am PDTCARD ORDER FORM Uploaded by RV Jensen Admin - credit@rvjensen.com IP 206.169.107.66
July 30, 2019 1:33 pm PDTEddie 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 PDTEddie 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 PDTCredit 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 PDTCredit 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 PDTCredit 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 PDTCredit 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 PDTCredit 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 PDTCredit 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 PDTCredit 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 PDTCredit 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 PDTCredit 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 PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 206.169.107.66