"Wright Express Invoice (Wex) Verification Form" - Florida

The Florida Department of Juvenile Justice has released this version of the "Wright Express Invoice (Wex) Verification Form" on November 1, 2017.

This form may be used by all Florida residents: download the printable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Download "Wright Express Invoice (Wex) Verification Form" - Florida

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Wright Express Invoice (WEX) Verification Form
I, ________________________, certify that Invoice Number __________________, in the
amount of $______________, and dated _____________, has been reviewed for accuracy and
the amount listed on the WEX Invoice is correctly assigned/charged to my account.
The original gas receipts are maintained at the Program Office level and may be provided upon
request.
Signature ___________________________ Date __________
Title ______________________________________________
Contact Number (___)__________________________
Save As
Print Form
Reset/Clear Form
Department of Juvenile Justice
General Services – Support Services
New 11/2017
Wright Express Invoice (WEX) Verification Form
I, ________________________, certify that Invoice Number __________________, in the
amount of $______________, and dated _____________, has been reviewed for accuracy and
the amount listed on the WEX Invoice is correctly assigned/charged to my account.
The original gas receipts are maintained at the Program Office level and may be provided upon
request.
Signature ___________________________ Date __________
Title ______________________________________________
Contact Number (___)__________________________
Save As
Print Form
Reset/Clear Form
Department of Juvenile Justice
General Services – Support Services
New 11/2017
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