FuelCard Refusal Form

Personal Details

Name

Email address

Email address (repeat)

Station Admin Office Address

Aral Card Details

VLO Vehicle Registration Number

Aral Card Number

Transaction Details

Invoice Number (Beleg-Nr)

Fuel Type Super Diesel

Litres Purchased

Price per Litre (EUR/l)

Total Cost (Gesamtbetrag)

Transaction Date

Refusal Description (500 chars left)

Please give a brief description of why the station did not accept your card. See the Info section of your receipt for the error notice.

Receipt

Upload Receipt ( jpg )

Upload Error slip ( jpg )

You must provide both a copy of the receipt and either the printed error slip or a signed note from the Aral Station stating the problem. Uploads are only permitted in .jpg format and the form will not submit if you use another image format. Please retain the original receipt.

Terms and Conditions

It is the card holder’s responsibility to ensure that the card is in date before use, there will be no refunds for out of date cards.

Aral requires your details to issue you with a 'Supercard', which will enable you to be reimbursed.

I agree to VLO sharing the details on this form with ARAL