Get Gas Card Application Form

PG E Process Time For New accounts 2-3 weeks Additional account cards 5-6 days New Card s Natural Gas Fueling Card Application Deactivate Card s Immediately To be used when opening a New Account or requesting New or Replacement Cards e.g. lost or damaged PG E Clean Air Transportation Hotline 1-800-684-4648 CUSTOMER ACCOUNT INFORMATION please complete one application per billing account Customer or Legal Business Name E-Mail Social Security No. or Calif. Drivers Lic. No. Federal Tax ID No. if not provided deposit may be required Businesses Only Billing -- Mailing Address City FAX No. Applicant s Name Please Print State Daytime Telephone Applicant s Signature Zip Date FUELING CARD ASSIGNMENT DATA THIS INFORMATION WILL BE DISPLAYED ON THE MONTHLY DETAIL OF BILL Each fueling card issued must be tied to a unique ID that is seven characters or less using numbers and/or letters. One card per vehicle. Example License Plate No* 1EFB687 or Vehicle No* B203 etc* You can use any identifier you d like. ID will appear on monthly Detail of Bill* Note For replacement cards the old one will be deactivated at the time the new card is made. Call for other arrangements. NEW REPL Unique Vehicle ID seven characters or less numbers and/or letters Vehicle Type Make Model Year If Replacement enter old card number PG E Use Only New Card No* Assigned Use Page 2 for additional card requests TO BE COMPLETED BY PG E CAT DEPT Card s Issued by Account Rep New Account PG E Address EWR3 NOTES PG E USE CDX Acct* No* Yes Group No* Page 1 PG E FAX No* 530 757-5240 CNG Fueling Applicationrevised10-25-05. doc This page is supplemental and only needs to be submitted if your request is for more than five cards Page 2. One card per vehicle. Example License Plate No* 1EFB687 or Vehicle No* B203 etc* You can use any identifier you d like. ID will appear on monthly Detail of Bill* Note For replacement cards the old one will be deactivated at the time the new card is made. ID will appear on monthly Detail of Bill* Note For replacement cards the old one will be deactivated at the time the new card is made. Call for other arrangements. NEW REPL Unique Vehicle ID seven characters or less numbers and/or letters Vehicle Type Make Model Year If Replacement enter old card number PG E Use Only New Card No* Assigned Use Page 2 for additional card requests TO BE COMPLETED BY PG E CAT DEPT Card s Issued by Account Rep New Account PG E Address EWR3 NOTES PG E USE CDX Acct* No* Yes Group No* Page 1 PG E FAX No* 530 757-5240 CNG Fueling Applicationrevised10-25-05. Call for other arrangements. NEW REPL Unique Vehicle ID seven characters or less numbers and/or letters Vehicle Type Make Model Year If Replacement enter old card number PG E Use Only New Card No* Assigned Use Page 2 for additional card requests TO BE COMPLETED BY PG E CAT DEPT Card s Issued by Account Rep New Account PG E Address EWR3 NOTES PG E USE CDX Acct* No* Yes Group No* Page 1 PG E FAX No* 530 757-5240 CNG Fueling Applicationrevised10-25-05. doc This page is supplemental and only needs to be submitted if your request is for more than five cards Page 2.