REQUEST AND AUTHORIZATION FOR ADDITIONAL GAS OR DIESEL FUEL

(AE Reg 600-17)

Data Required by the Privacy Act of 1974
Authority: 10 USC 3012.
Principal purpose(s): Distribution control of additional POV fuel rations.
Routine use(s): See routine uses set forth at 40 Federal Register 35151.
Disclosure: Mandatory - to be used to cross-reference name and verification requirements. SSN disclosure is voluntary.

Please provide information for each block. Enter "N/A" if there is no info to provide.
Please e-mail (rmvcustsvc@eur.army.mil) or fax (DSN 386-7107 or civilian 0621-718-7107) completed and approved forms.

To HQ, USAREUR Vehicle Registry Fax number E-mail address

ATTN: Customer Service DSN 386-7107 rmvcustsvc@eur.army.mil
Unit 29230 Civ 0621-718-7107
APO AE 09086-9230
Request for specific month or up to 1 year (for personal Reason or justification for increased allotment
travel must submit monthly)

Make and type of car

Number of cylinders

Horsepower

Year

Vehicle license plate number

Odometer reading

Average miles per gallon

Supplement requested (NTE monthly basic ration or

NTE 400 liters)

Date of last request

Current monthly basic fuel ration for this vehicle

Request approval to purchase extra gasoline/diesel fuel in the amount indicated in addition to authorized monthly ration.

Typed name (last, first, MI) Grade SSN Organization or division

Telephone number Fax number E-mail address

Signature

To be completed by the approving authority

(a person at or above company grade, squadron commander, or equivalent-level civilian)
in the requester's chain of command or supervision.
Typed name (last, first, MI) Grade Position Signature Date

Vers. 01.00 Page 1 of 1

AE Form 600-17A, FEB 09 Previous editions are obsolete.