Please upload a copy of your receipt:
Upload picture
What type of purchase did you make on this visit (check all that apply):
Purchased fuel and paid in the store
Purchased fuel and paid at the pump
Purchased non-fuel items and paid in the store
Record the number of the pump you used to purchase fuel:
Employee Name - Forecourt:
Gender:
Male
Female
Hair Length:
Hair Color:
Glasses: Yes
No
Approximate Height:
Employee Name - Backcourt:
Gender:
Male
Female
Hair Length:
Hair Color:
Glasses: Yes
No
Approximate Height: