Gas Station Receipt Template
What is it?
A pump receipt example showing fuel grade, gallons dispensed and price, plus a convenience-store item — the standard forecourt printout.
Last updated:
SUMMIT FUEL STOP
1200 Ridge Route
Hillcrest, ST 00000
(555) 343-8800
10/17/2026
07:52 AM
| 1 | Premium 93 — 9.86 gal | $42.30 |
| 1 | Coffee 16oz | $2.19 |
Subtotal$44.49
Tax (6%)$2.67
TOTAL$47.16
CARDVISA ****0000
Pump 07 — Come again!
Sample receipt — all business names are fictional.