Authorized Fleet Contact Form

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pages of Authorized Fleet Contacts.

Authorized Fleet Contacts
FleetOne, L.L.C.

The purpose of this form is to authorize select employee(s) to make inquiries and changes to your account.
Example: Deactivate/Activate cards, changing limits, check account balance, etc.

******This form MUST be signed by an authorized person before any additions can be made******

*Denotes required fields.

To add another click here:

1. Employee Name*:

2. Check One*:

Add • Change • Delete => this employee.

3. Employee Number (Up to 6 Numeric Digits):

4. Social Security Number:

5. Security Code Number* (4-10 Numeric Digits):

6. Maximum Limit Per Authorization ($):

7. Can Authorize (Check those that apply):

FUEL • MAINT/CAR WASH
ADDITIVES • MISC • ALL

8. Home Phone Number*:

9. Allowed to call at home for emergencies: YES • NO

Relevant Information Regarding the Above
* Denotes required fields.
2. If none selected, person listed will be added (“Add”).
3. If left blank, number will be assigned by Fleet One™.
3. and 5. Remember this information. This will be required to alter the account and should NOT be given out to anyone except Fleet One™ and authorized fleet agents. Example of Security Code may be last 4 digits of social security number or date of birth.
6. Limit is $2,000 if no maximum is designated.
7. If none are circled, ALL will be allowed.
8. Required for touchtone authorization and recommended for emergency contact.

The information on this form will remain confidential and will be used by Fleet One™ personnel only to maintain reliable security levels.

I, (Name), hereby authorize the person(s) listed above to carry out security related duties for the company as stated for each. I have read and understand this document.

Fleet Company Name:

Account Number:

OR New Account

Title:

Existing Accounts Fax this completed form to: 615-315-4008
New Accounts Fax to your Fleet Card Consultant.