Request, Replace, Or Deactivate Nys Fuel Credit Card Request Form - New York Office Of General Services

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Fleet Management
Office of
Harriman State Office Campus
Building 18
General Services
Albany, NY 12226
Phone: (518) 457-1744
Request, Replace, or Deactivate NYS Fuel Credit Card Request Form
Fax: (518) 457-7263
Email:
OGS.sm.Fleet.Admin@ogs.ny.gov
Agency Code
Agency Name
Date Requested
Agency Contact
Contact Email
Contact Phone Number
Gallon Limit
Action
Reason
Card Type
Product
Supervisor or Crew Name
(Supervisor & Crew
Code
Code
Code
State Vehicle ID
License Plate
Code
Cards Only)
(Supervisor & Crew Cards Only)
(select)
(select)
(select)
(select)
(select)
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Action Code
Reason Code
Card Type Code
Gallon Limit
Product Code
N = New Card
S = Stolen
L = Location Card
0 = Any Product
5
50
R = Replacement Card
L = Lost
V = Vehicle ID Card
2 = Diesel Fuel
12
70
D = Deactivate Card
W = Worn or Broken
S = Supervisor Card
4 = Unleaded Gas or Hybrid
20
120
C = Change in Card information
C = Crew Card
5 = Two Cycle Gas
30
200
E = Error
6 = CNG Dedicated or CNG Unleaded or Diesel (Bi-Fuel)
40
Form Date: 08/01/2016
P = License Plate Change
8 = Propane Dedicated or Propane Unleaded (Bi-Fuel)
9 = Ethanol and Unleaded or Diesel (FlexFuel)

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