PT. Mitsubishi Motors Krama Yudha Sales Indonesia
E – TOLL SHEET
User Name/Nama : E-Toll Card Number/No. Kartu E-Toll :
Driver Name/Nama Pengemudi : Period/Periode :
Type Of Vehicle & Police No./Jenis Kendaraan & No. Polisi : Balance Brought/Pengisian Perdana :
Top Up/Pengisian Ulang :
Date Route/Rute Time Toll Gate Balance Brought Payment Balance Balance Carried User Sign Remarks
(Tanggal) From/(Dari) To/(Tujuan) (Jam) (Pintu Toll) (Saldo Awal) (Dibayarkan) (Sisa Saldo) (Sisa Saldo) (Paraf User) (keterangan)
Checked By : Prepared By : Approved By :
(Dikontrol Oleh) (Disiapkan Oleh) (Disetujui Oleh)
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Date Route/Rute Time Toll Gate Balance Brought Payment Balance Balance Carried User Sign Remarks (Tanggal) From/(Dari) To/(Tujuan) (Jam) (Pintu Toll) (Saldo Awal) (Dibayarkan) (Sisa Saldo) (Sisa Saldo) (Paraf User) (keterangan)