Fuel Card Order Form

Fill out, print and mail to: REC/Fleet Fuel, 9 Hylestead St, Providence, RI 02905

One Card System	Two Card System
Vehicle Numbers:
Company Name:
Address:
Gallon Limits:
#1) 10 #2) 20 #3) 30 #4) 40 #5) 50 #6) 75 #7) 150 #8) 250 #9) 500 #10) 999
Manual Entry:
04 PIN # Only 05 PIN # Odometer 06 PIN # & Manual Entry 07 PIN # & Odometer & Manual Entry
Expiration Date:
Request By:
Availability:
Product Code:
All Products Regular Unleaded Only Unleaded Only Diesel Only BIO Diesel All Gasoline Products
Billing:	Weekly Bi-Weekly Monthly
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