Xpress Fuel Multi Tank Metered Delivery Ticket

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Fill in all boxes below:

Date required

Time

Drivers Name

Vehicle Reg

Order Number

Delivery Postcode

Please ask the customer to read, fill in and sign the below declaration before delivery.

Customer Declaration

I, the customer, confirm that the tank ullage has been checked, and there is sufficient room for the quantity and grade ordered. In the event of any spillages or incidents during delivery, I, the customer, will be fully liable and responsible. If I, the customer, am not present to sign the declaration, I authorise the driver/carrier/supplier to continue the delivery on my behalf, I, the customer, accept full liability and responsibility.
Warning - Gas Oil or Kerosene is not to be used as road fuel.

Full Name

Position

Customer Signature

Tank 1

Tank 1 REF / Number

Delivered Quantity 1

Tank 2

Tank 2 REF / Number

Delivered Quantity 2

Tank 3

Tank 3 REF / Number

Delivered Quantity 3

Tank 4

Tank 4 REF / Number

Delivered Quantity 4

Tank 5

Tank 5 REF / Number

Delivered Quantity 5

Tank 6

Tank 6 REF / Number

Delivered Quantity 6

Tank 7

Tank 7 REF / Number

Delivered Quantity 7

Tank 8

Tank 8 REF / Number

Delivered Quantity 8

Tank 9

Tank 9 REF / Number

Delivered Quantity 9

Tank 10

Tank 10 REF / Number

Delivered Quantity 10

Tank 11

Tank 11 REF / Number

Delivered Quantity 11

Tank 12

Tank 12 REF / Number

Delivered Quantity 12

Tank 13

Tank 13 REF / Number

Delivered Quantity 13

Tank 14

Tank 14 REF / Number

Delivered Quantity 14

Tank 15

Tank 15 REF / Number

Delivered Quantity 15

TOTAL QUANTITY DELIVERED

Total Qty Delivered

Attach Meter Photo Of Total QTY Delivered

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Driver Comments

To be completed after delivery has been made

Recieved by (Full Name)

Recieved by Position

Recieved by Signature