Request for Vehicle Use

DATE OF REQUEST:

EMPLOYEE MAKING REQUEST:

DATE AND TIME OF DEPARTURE:

DATE AND TIME OF RETURN:

NAME OF PASSENGERS:

DESTINATION:

PURPOSE OF TRIP:

WILL GAS CREDIT CARD BE NEEDED*? YES ( ) NO ( )

*Please contact the Finance Office to check-out the gas card. Card must be returned no later than two business days

following the scheduled return date.

SIGNATURE OF PERSON MAKING REQUEST

------

APPROVED: ( ) DISAPPROVED: ( )

VEHICLE ASSIGNED: #

DIRECTOR OF PHYSICAL PLANT or MAINT SUPERVISOR

VEHICLE LIST

TAG MODEL MAKE CAPACITY

#316 2013 DODGE CARAVAN 7 PASSENGER

#778 2012 DODGE CARAVAN 7 PASSENGER

#401 2009 CHEVROLET COLORADO 2 PASSENGER

#780 2007 DODGE CARAVAN 6 PASSENGER

#866 2007 FORD VAN 10 PASSENGER

#224 2005 DODGE CARAVAN 6 PASSENGER

#818 2005 DODGE CARAVAN 6 PASSENGER

#817 2005 DODGE CARAVAN 6 PASSENGER

#646 2004 FORD TAURUS 4 PASSENGER

#629 2001 DODGE VAN 8 PASSENGER

#865 1994 FORD VAN 7 PASSENGER