FUEL ADVANCE AUTHORIZATION                                   

FUEL ADVANCES(50%) MUST BE AUTHORIZED BY DISPATCHER/ OWNER OF EQUIPMENT BEFORE FUEL ADVANCE CAN BE ISSUED TO DRIVER AFTER LOADING.  PLEASE PRINT THIS PAGE,   FILL IN THE FIELDS, AND FAX TO US.

CARRIER: __________________________________ MC#_____________________________

AUTHORIZED DISPATCHER/OWNER:_____________________________________________

DRIVER'S NAME(LAST/FIRST/TRACTOR #):________________________________________

DRIVER'S NAME(LAST/FIRST/TRACTOR #):________________________________________

IF AMOUNT IS TO LIMITED TO LESS THAN 50%, STATE AMOUNT: $___________________

AUTHORIZATION FOR ONE TIME ONLY ADVANCE:    YES:_____   NO:_____

AUTHORIZATION PERMANENT:                                      YES:_____   NO:_____

AUTHORIZED SIGNATURE:_____________________________DATE:____________________

TOLL FREE#:____________________________LOCAL#:_______________________________

ALL ADVANCES UNDER $999.99=$10.00 FEE    OVER $1000.00=$20.00 FEE