Outside New Fuel Key Request - NCDOT



NORTH CAROLINA DEPARTMENT OF TRANSPORTATION

AUTOMATED FUEL SECTION

OUTSIDE AGENCY NEW FUEL KEY REQUEST FORM

|EQUIPMENT |YEAR AND DESCRIPTION |LICENSE |AGENCY |AGENCY NAME |ADDITIONAL |FUEL |INSERT LETTER OF FLEX FUEL TYPE AND/OR INSERT |

|NUMBER | |NUMBER |NUMBER |INTIALS |COMMENTS |TAN K |NUMBER FOR OTHER FUEL TYPE |

| | | | | | |CAPACITY | |

|LEAVE |EXAMPLE | |(EX.) |PUBLIC |ENTER ANY ADDITIONAL| |CHOOSE LETTER FOR FUEL TYPE |

|AREA | |PS-1234 | |AFFAIRS |DATA HERE | |A 13 GASOHOL ONLY |

|BLANK |2017 | |12345 |(EX.) | | |B 2-11 DIESEL & BIO-DIESEL |

|OR ENTER AGENCY |CHEVY VAN | | | | |25.0 |C 10-13 ETHANOL & GASOHOL |

|ASSIGNED | | | |PAD | | |(FLEX FUEL) |

|NUMBERS | | | | | | |SINGLE FUEL TYPES |

|BELOW | | | | | | |8 PROPANE |

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PLEASE ENTER ADDITIONAL VEHICLES ON A NEW FORM.

DATE KEYS ENCODED: ______________________ KEYS PROCESSED BY _____________________________________________

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