VEHICLE REQUEST FORM

Employee Requesting Vehicle      Campus      Department/Division

Type of Vehicle        Destination

Number of Persons    Name(s) of Passengers*

Purpose of Trip

Date/Pick Up Time        Date/Time of Return

Driver’s License #        Expiration Date

*Note: Passenger Liability Waiver Required for All Unauthorized Passengers.

_______________________________________________    ______________

Signature of Employee Requesting Vehicle        Date

APPROVAL:

______________________________________    __________________________________

Supervisor of Employee    Date      Transportation Coordinator    Date

Original: Transportation Coordinator; Copy: Employee

Form 1382/001 (9/04)

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