> ![](media/image1.png){width="2.0in" height="0.48194444444444445in"}

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<tbody>
<tr class="odd">
<td colspan="26"><p>U.S. Department of the Interior</p>
<p>Vehicle Card Account Application Form</p>
<h3 id="section"></h3></td>
</tr>
<tr class="even">
<td colspan="5"><p id="account-type-vehiclefleet-card"
class="heading">Account Type: VEHICLE/FLEET CARD</p>
<p><strong>ACTIVATED UPON ISSUE</strong></p></td>
<td colspan="10"><strong>Return Copy to:</strong></td>
<td colspan="11"><p>Bank of America Government Card Services</p>
<p>P.O. Box 1637</p>
<p>Norfolk, VA 23501‑1637</p>
<p><strong>Facsimile: (757) 441‑4993</strong></p>
<p><strong>(888) 784‑1039</strong></p></td>
</tr>
<tr class="odd">
<td colspan="2"><p id="central-account" class="heading">CENTRAL ACCOUNT
#</p></td>
<td>5</td>
<td>5</td>
<td colspan="2">6</td>
<td colspan="2">8</td>
<td><strong>‑</strong></td>
<td>1</td>
<td>6</td>
<td>0</td>
<td>0</td>
<td><strong>‑</strong></td>
<td colspan="2">0</td>
<td>0</td>
<td>0</td>
<td>0</td>
<td colspan="2"><strong>‑</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="26"><p id="section-1" class="heading"> </p></td>
</tr>
<tr class="odd">
<td><h1 id="credit-limit">Credit Limit</h1></td>
<td colspan="6"><strong>$</strong></td>
<td colspan="13"><strong>Authorization Option#</strong></td>
<td colspan="6"></td>
</tr>
</tbody>
</table>

<table>
<colgroup>
<col style="width: 8%" />
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<col style="width: 3%" />
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<tr class="odd">
<td colspan="7"><h6 id="to-be-completed-by-field-office">TO BE COMPLETED
BY FIELD OFFICE</h6></td>
<td colspan="4">PLEASE TYPE OR PRINT ALL INFORMATION</td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="8"></td>
</tr>
<tr class="odd">
<td colspan="3"><strong>(1) VEHICLE LICENSE NUMBER</strong></td>
<td colspan="2"></td>
<td colspan="4"><strong>(2) VEHICLE TYPE/VIN/EQUIPMENT</strong></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="11"><strong>(3) FIELD OFFICE MAILING ADDRESS</strong></td>
</tr>
<tr class="odd">
<td colspan="3"><strong>Address Line 1: ATTN</strong>:</td>
<td colspan="8"></td>
</tr>
<tr class="even">
<td colspan="3"><strong>Address Line 2:</strong></td>
<td colspan="8"></td>
</tr>
<tr class="odd">
<td colspan="3"><strong>Address Line 3:</strong></td>
<td colspan="8"></td>
</tr>
<tr class="even">
<td><strong>City:</strong></td>
<td colspan="3"></td>
<td colspan="2"><strong>State:</strong></td>
<td colspan="2"></td>
<td colspan="2"><strong>Zip Code:</strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>BUSINESS PHONE:</strong></td>
<td colspan="9"></td>
</tr>
<tr class="even">
<td colspan="11">By signing below, I (a) request that a Government
Vehicle Card be issued to me for the above vehicle, (b) agree that I
will authorize use of the Card for official expenses only, in accordance
with Agency/Organization policy, and be bound by the terms and
conditions of the attached Agreement governing use of the Government
Card, and (c) authorize Bank of America to verify information on this
application. <strong>PLEASE RETAIN A COPY FOR YOUR
RECORDS.</strong></td>
</tr>
<tr class="odd">
<td colspan="11"><strong>(4) LOCAL OPERATOR SIGNATURE</strong>
__________________________________________ <strong>Date</strong>
______________</td>
</tr>
</tbody>
</table>

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<tr class="odd">
<td colspan="13"><strong>TO BE COMPLETED BY AGENCY PROGRAM
COORDINATOR</strong></td>
<td colspan="7">PLEASE TYPE OR PRINT ALL INFORMATION</td>
</tr>
<tr class="even">
<td colspan="6"><strong>(5) ACCOUNTING CODE:</strong></td>
<td colspan="14"></td>
</tr>
<tr class="odd">
<td colspan="6"><strong>(6) TAX EXEMPT NUMBER:</strong></td>
<td colspan="5"></td>
<td colspan="9"><strong>CARD TYPE: STANDARD</strong>
<strong>GENERIC</strong> </td>
</tr>
<tr class="even">
<td colspan="20"><strong>(7) Please Complete the Account Hierarchy
Below:</strong></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>HL1</strong></td>
<td colspan="3"><strong>HL2</strong></td>
<td colspan="2"><strong>HL3</strong></td>
<td colspan="2"><strong>HL4</strong></td>
<td colspan="5"><strong>HL5</strong></td>
<td colspan="3"><strong>HL6</strong></td>
<td colspan="2"><strong>HL7</strong></td>
<td><strong>HL8</strong></td>
</tr>
<tr class="even">
<td colspan="2"><strong>0000003</strong></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="5"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="20">By signing below, I hereby authorize, on behalf of the
Agency/Organization indicated above, that a Government Vehicle Card be
prepared and mailed to the local employee named above. <strong>PLEASE
RETAIN A COPY FOR YOUR RECORDS.</strong></td>
</tr>
<tr class="even">
<td colspan="3"><p><strong>(8) A/OPC</strong></p>
<p><strong>Last Name</strong></p></td>
<td colspan="9"></td>
<td colspan="4"><p><strong>A/OPC</strong></p>
<p><strong>First Name</strong></p></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="20"><strong>(9) A/OPC ADDRESS</strong>
<strong>INFORMATION</strong></td>
</tr>
<tr class="even">
<td colspan="4"><strong>Address Line 1: ATTN</strong>:</td>
<td colspan="16"></td>
</tr>
<tr class="odd">
<td colspan="4"><strong>Address Line 2:</strong></td>
<td colspan="16"></td>
</tr>
<tr class="even">
<td colspan="4"><strong>Address Line 3:</strong></td>
<td colspan="16"></td>
</tr>
<tr class="odd">
<td><strong>City:</strong></td>
<td colspan="7"></td>
<td colspan="2"><strong>State:</strong></td>
<td colspan="5"></td>
<td colspan="3"><strong>Zip Code:</strong></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="4"><strong>(10) BUSINESS PHONE:</strong></td>
<td colspan="8"></td>
<td colspan="4"><strong>(11) FAX #:</strong></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="4"><strong>(12) SIGNATURE:</strong></td>
<td colspan="8"></td>
<td colspan="4"><strong>(13) DATE:</strong></td>
<td colspan="4"></td>
</tr>
</tbody>
</table>

NOTE: See the Agreement between the Agency/Organization Employee and
Bank of America for the terms and condi­tions of your Account.

##### Vehicle Card Account Application Form

INSTRUCTIONS FOR COMPLETION OF FORM

1.  VEHICLE LICENSE \# ‑ enter the I or M tag number. Example: I-123456
    or M-654785

2.  VEHICLE TYPE/VIN/EQUIPMENT ID- enter the vehicle type,
    identification or equipment ID number.

3.  FIELD OFFICE MAILING ADDRESS ‑ enter the official field office
    address where the account statement should be mailed via the U.S.
    Postal Service. Delivery time from Bank of America receipt of the
    fax is about seven days. If you need the card sooner, write "Code
    Red" on the top of the form and use a delivery address for FEDEX
    delivery. If you want the monthly account statement mailed to a
    different address than the FEDEX address, the address will have to
    be changed in EAGLS after the account is initiated.

4.  LOCAL OPERATOR SIGNATURE & DATE ‑ signature of the employee
    requesting the new fleet card, and the date of signature. This is
    for local information only and is not required.

5.  ACCOUNTING CODE ‑ Enter the default accounting code for the vehicle.
    Please ensure that you use the appropriate bureau format, including
    the BOC. Do not include any spaces in this accounting code.

6.  TAX EXEMPT NUMBER -- Enter Agency/Organization's tax-exempt number
    and card type.

7.  FLEET HIERARCHY CODE ‑ enter the remainder of the FLEET HIERARCHY
    CODE, which is appropriate for that field office.

8.  A/OPC LAST AND FIRST NAMES ‑ enter the last name and first name of
    the A/OPC approving the application.

9.  A/OPC ADDRESS INFORMATION --

> [Line 1]{.underline}- the first line of the agency address should
> start with the bureau or office Attn: to the individual receiving to
> card. Field length available 40 positions. Data Type: Alphanumeric
>
> [Line 2]{.underline}- if needed; continue with the street, P.O. Box or
> other address information.

Field length available 40 positions. Data Type: Alphanumeric

[Line 3]{.underline}- if needed; continue with the street, P.O. Box or
other address information.

Field length available 40 positions. Data Type: Alphanumeric

10. A/OPC PHONE \# ‑ enter the A/OPC's office phone number.

11. A/OPC FAX \# ‑ enter the FAX \# used by the APC.

12. A/OPC Signature ‑ signature of the A/OPC approving the application.

13. DATE ‑ enter the date A/OPC approved the application

After the form is completed, it should be faxed to Bank of America at
the fax number shown at the top of this form.