Facilities Management Office

Vehicle Reservation Request & Billing Form (Rev. 12/03)

Instructions:

  1. Location of Vehicle Reservations Forms: Facilities Mgt Office or University web page.
  2. Reservations: Call Ext. 2213 concerning availability of vehicles.
  3. Request Form: Complete departmental section of form and return to the Facilities Mgt Office. At the end of each month, the Facilities Mgt Office will forward a copy of cost incurred to the department secretary.
  4. Confirmation of reservation: Only a COMPLETED vehicle reservation form RECEIVED by the Facilities Mgt Office confirms your reservation.
  5. Issuance of Keys: Pick up packets with keys, gasoline credit card, and trip record cards at the Facilities Mgt Office on Monday through Friday between 8:00 a.m. and 4:30 p.m. For departure at times other than during working hours, pick up keys before the close of business prior to departure. Upon return, the packets with credit card, keys, trip record card, and receipts should be deposited in the Motor Pool drop box in the Motor Pool parking lot (2219 Cedar St.).

Check one:

[ ] Student

[ ] Employee

Driver's Name _______________________

Phone number or ext. ____________

__________________________________ / _____
Car, Minivan, 11-12 pass Van, 14 pass Bus / # of passengers

Destination (City/State) __________

Function _________________________________

Group/Dept Name __________________

Time of Departure _______ [ ]AM [ ]PM Day of week __________ Date (MM/DD/YY) _________

Time of Return _________ [ ]AM [ ]PM Day of week __________ Date (MM/DD/YY) _________

Dept Account # __-_____-_________-_______

U.C. Box _______

Budget Authority Signature ______________________

Date __________

Ext. ________

-------------------------------- DO NOT WRITE BELOW -- FACILITIES OFFICE USE ONLY ---------------------------------

Vehicle No. _________________________________

Credit Card No. ___________________________

Trailer Key No. ______________________________

Trip Record Card No. _______________________

_______________________________________________________________________________________________

BILLING:

Return Mileage _______________ Departure Mileage ________________ Total Mileage ________________

Rate ________________________________________

Mileage Charges ______________________________

Misc. Charges ________________________________

___________________________________________
Charges may include: Cleaning fees, not refueling, not completing Trip Card,
damage due to accident, etc. (See Motor Pool Policy and Procedures)

Driver ________________________________

Total Passengers ________ Drive Hour ______

Total Charges ________________________

Date Submitted: _________________