Department of Integrative Biology
Departmental Van Rental Form
Part 1: Please list every person that will be in the van in one of these three categories:
*Primary Driver:
Driver Profile
*Other Drivers:
Driver Profile
Driver Profile
Driver Profile
*
Passengers:
(Will NOT be driving)
Part 2: Please indicate the purpose of the trip, all destinations, expected time of travel and
chargeback information:
67 68
71
*Circle the van being rented
*Departure Date & Time *Return Date & Time
*Odometer Reading (out):
(back):
Total Km to be charged
:
*Authorization for Charge (Sign and Print Name) Date
*Chair’s/ Chair's Designate Signature Date
*Signature of Primary Driver Date
*It is mandatory that these fields be completed
PRIOR
to the keys being given out. Please
submit
completed form to
Connie Davison (SSC 2484).
Remember to take a copy of the form with you to
record the odometer readings & return the completed copy with the keys
.*
Grant #or course code to be charged (.48/km)
Parking tickets, towing charges or toll charges will be charged to your grant.
click to sign
signature
click to edit
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