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gas-pump
Company Card Expense
Fuel
13
Questions
START
1
Employee Name
*
This field is required.
First Name
Last Name
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2
Date of Fuel Purchase
*
This field is required.
-
Date
Year
Month
Day
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3
Gas Station
*
This field is required.
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4
Vehicle
*
This field is required.
Blue - 2016 F-150
Gray - 2020 Ford Ranger
White - 2020 Ford Ranger
Black - 2019 F-150
Red - 2019 Ford Ranger (Sales)
Rental Truck
Blue - 2016 F-150
Gray - 2020 Ford Ranger
White - 2020 Ford Ranger
Black - 2019 F-150
Red - 2019 Ford Ranger (Sales)
Rental Truck
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5
Odometer
*
This field is required.
How many miles on the vehicle when fuel was added?
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6
Odometer Accuracy
*
This field is required.
Was the odometer reading exact or estimated?
Exact
Estimated - I'll do better next time
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7
How many gallons?
*
This field is required.
Include decimals; do not round
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8
Receipt Total ($)
*
This field is required.
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9
Cost per Gallon
Auto-calculated
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10
Last 4 digits of card used for purchase
*
This field is required.
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11
I certify
*
This field is required.
I certify that all information entered above is valid and true.
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12
Upload Receipt Here
*
This field is required.
Drag and drop files here
Select files to upload
Max. file size
: 15.5MB
Browse Files
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13
Please verify that you are human
*
This field is required.
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14
Signature
*
This field is required.
Clear
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