Motor Pool Vehicle Request Form

Primary Driver Name Primary Driver Name First Last
Secondary Driver Name (if applicable) Secondary Driver Name (if applicable) First Last
Department Name:
Department Account Number:
Select a Vehicle
Driver's Safety Course Taken?

Driver's Safety Course Taken? Yes
Total number of passengers (including driver):
Pick-Up Date: Pick-Up Date: / MM / DD YYYY

Validate that the date selected is after the current date.
Pick-Up Time: Pick-Up Time: : HH MM AM/PM

Vehicles will NOT be ready for pick up until time specified above.
Return Date: Return Date: / MM / DD YYYY
Return Time: Return Time: : HH MM AM/PM
Destination:
Person of Contact's Email:
Person of Contact's Phone Number: Person of Contact's Phone Number: - ### - ### ####
Additional Comments:
Use of a university owned vehicle is with the understanding that it will be driven only by a university employee having a valid driver license. Vehicle will be used ONLY for official university business.

Use of a university owned vehicle is with the understanding that it will be driven only by a university employee having a valid driver license. Vehicle will be used ONLY for official university business. I agree
I have read and agree to the policies located on the Motor Pool webpage.

I have read and agree to the policies located on the Motor Pool webpage. I agree
I understand there will be a $50 charge to my department if I fail to cancel reservation 24 hours prior to reserved time.

I understand there will be a $50 charge to my department if I fail to cancel reservation 24 hours prior to reserved time. I agree