Fuel Card Request Form

Requestor Name: Email:
New Replacement Reason:
Department: Phone#:
Dept. Head: Email:
Vehicle Information required:
Vehicle#: (6 digit number assigned by Physical Plant)
Vehicle Description:
Year: Make:
Model: VIN#:

Please Note:

1. Each driver must complete Driver authorization code (PIN) request form in order to receive their PIN.

2. Fuel expenses will be charged to the FOAP associated with the driver of the vehicle.

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