Gas Receipt Form For District Van And Fuel Card Use
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1Gas Receipt Form
For District Van and Fuel Card Use
Trav el date(s):
V an number:
Driv er name:
Ty pe 2 Licensed Driv er: ☐ Y es
☐ No
Destination:
Purpose:
City and State
Event you are attending
Representing: ☐ Cascade High School
Ev ent ty pe: ☐ ASB
(ASB advisor authority required)
☐ Ev erett High School
☐ Athletics
(athletics director authority required)
☐ HM Jackson High School
☐ School
(school principal authority required)
☐ Sequoia High School
☐ District
(district/department authority required)
☐ Other School Building
☐ Other District Building
EXAMPLE:
SUBTRACT
EQUALS
DIVIDE BY
EQUALS
25,532
-
24,975
=
557
/
32.7
=
17.03
Ending mileage
Starting mileage
Miles driven
Gallons purchased
MPG
ENTER Y OUR INFORMATION HERE:
SUBTRACT
EQUALS
DIVIDE BY
EQUALS
0
-
=
/
=
Ending mileage
Starting mileage
Miles driven
Gallons purchased
MPG
$
Account Code:
T otal fuel charge:
Tape Receipt Here
Driv er has:
☐ Refueled the v ehicle to FULL
(tape additional receipts to back of form)
☐ Cleaned and remov ed debris from v ehicle
Driv er Signature:
Budget Authority:
ASB – Advisor
ATHLETICS – Dis trict Athletic Director
SCHOOL – School Building Principal
DISTRICT – Department Budget Authority
ASB Authorities:
ASB - Secretary
ASB - Student
ASB – Administrator
DISCLA IMER: Driver is responsible for the district gas credit card. Credit cards should
never be left in district vehicles or attached to the keys. Credit cards s hould be stored in a
s ecure place at all times. Keys s hould be returned to a secure and locked area.
Revised 10/16
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Parent category: Business