To be used when opening a New Account, or requesting New or Replacement Cards / New Card(s)
Deactivate Card(s)
Immediately
(e.g. lost or damaged)
PG&E Clean Air Transportation Hotline: 1-800-684-4648
CUSTOMER ACCOUNT INFORMATION (please complete one application per billing account)
Customer or Legal Business Name: / E-Mail:
Social Security No.: / or Calif. Drivers Lic. No. / Federal Tax ID No.
(if not provided, deposit may be required): / (Businesses Only):
Billing -- Mailing Address: / City: / State: / Zip:
Applicant’s Name (Please Print): / FAX No.: /

Daytime

Telephone:
Applicant’s Signature: / Date:

FUELING CARD ASSIGNMENT DATA

**THIS INFORMATION WILL BE DISPLAYED ON THE MONTHLY DETAIL OF BILL**

Each fueling card issued must be tied to a unique ID that is seven characters or less, using numbers and/or letters. (One card per vehicle.)
(Example: License Plate No. = 1EFB687, or Vehicle No. = B203, etc. You can use any identifier you’d like. ID will appear on monthly Detail of Bill.)
Note: For replacementcards – the old one will be deactivated at the time the new card is made. Call for other arrangements.
NEW / REPL / ** Unique Vehicle ID ** / ** Vehicle Type ** / If Replacement enter
old card number: / PG&E Use Only
 /  / (seven characters or less,
numbers and/or letters) /
Make
/
Model
/
Year
/ New Card No. Assigned:
1
2
3
4
Use “Page 2” for additional card requests
TO BE COMPLETED BY PG&E CAT DEPT: / NOTES: (PG&E USE)
Card(s) Issued by: / Date:
Account Rep: / CDX Acct.No.:
New Account:Yes / Yes / Group No.:
PG&E Address: / PG&E - Clean Air Transportation, ATTN: Adam Egbert, 202 Cousteau Place, Suite 150, Davis, CA 95616 PG&E FAX No.: (530) 757-5240

EWR3Page 1CNG Fueling Application_revised_10-25-05.doc

PG&E Clean Air Transportation Hotline: 1-800-684-4648
Customer or Legal Business Name:

FUELING CARD ASSIGNMENT DATA

**THIS INFORMATION WILL BE DISPLAYED ON THE MONTHLY DETAIL OF BILL**

Each fueling card issued must be tied to a unique ID that is seven characters or less, using numbers and/or letters. (One card per vehicle.)
(Example: License Plate No. = 1EFB687, Vehicle No. = B203, etc. You can use any identifier you’d like. ID will appear on monthly Detail of Bill.)
Note: For replacementcards – the old one will be deactivated at the time the new card is made. Call for other arrangements.
NEW / REPL / ** Unique Vehicle ID ** / ** Vehicle Type ** / If Replacement enter old
card number: / PG&E Use Only
 /  / (seven characters or less,
numbers and/or letters) /
Make
/
Model
/
Year
/ New Card No. Assigned:
5
6
7
8
9
10
11
12
13
14
15
16
17
(This page is supplemental and only needs to be submitted if your request is for more than five cards)
PG&E Address: / PG&E - Clean Air Transportation, ATTN: Adam Egbert, 202 Cousteau Place, Suite 150, Davis, CA 95616 PG&E FAX No.: (530) 757-5240

EWR3Page 2CNG Fueling Application_revised_10-25-05.doc