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Name
*
First
Last
Name Last Signature
Fuel Card
*
--- Select Choice ---
Allocate
Deallocate
Reason
Choose a Reason Here
Blocked
Cancelled
Spare
Only if applicable
Last 6 digits of card
*
Picture of card
*
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Capture With Your Camera
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Front picture of fuel card
Drivers Signature
*
Clear Signature
OSM Name
*
Signature
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