OFFICE USE ONLY
		Card Number
		Issue Date
PRE-PAID FUEL APPLICATION
UNIVERSITY AIRPORT
UNIVERSITY OF CALIFORNIA, DAVIS
DAVIS, CALIFORNIA
NAME:
ADDRESS:
PHONE NUMBER:
EMAIL ADDRESS:
DELIVERY METHOD: (select one)
□	A. Mail to above address.
□	B. Pick up at University Airport Office
□	C. Pick up at Transportation and Services Parking Office
GENERAL INFORMATION:
1. This application is being submitted to purchase fuel at the University Pre-paid Rate.
2. The pre-paid price will be posted at the fuel island.
3. The maximum amount that may be purchased at one time is $1500.
Payment will be accepted with cash or check only.
4. University Airport reserves the right to refuse service.
5. Should you have questions regarding the program you may call (530) 752-0100.
6. There is a cost of $5 per pre-paid card (this includes replacement cards).
7. Applications along with a check made payable to UC Regents may be mailed to:
	University Airport
	1 Shields Avenue
	University of California, Davis
	Davis, California 95616
8. Pre-paid cards will normally be available the next business day after submission of your application
9. Should you experience any problems with your pre-paid card you may call (530) 752-6346.
10. University Airport is not responsible for lost, stolen or misplaced cards.
11. University Airport is not responsible for fuel purchased with a lost/stolen/misplaced card.