Rental Car Reservation Form - (TA______)
ALL APPLICABLE FIELDS MUST BE COMPLETE
Please complete this form and send it to your department travel delegate. Once you have an approved Travel Authorization, you may
contact Sunflower Travel at (316) 733-2753 to make your reservation.
**Please note: Authorization numbers are NOT transferable. If an authorization is created under your name, you are the ONLY one
that can rent a car with that authorization number.
PRIMARY DRIVER INFORMATION
Name: ____________________________________ MyWSU ID Number: _______________________
Status: ___________________________ (State Employee)
Email address: _____________________________
BILLING INFORMATION
Department: _____________________________________
Organization Number: _________________ Fund Number: __________________
TRIP INFORMATION:
Date Leaving: ______________ Time Leaving: ____________
Date Returning: ______________ Time Returning: ____________
Trip Destination: ____________________________ Purpose of Trip: ________________________________
Multi-Passenger Vehicle Reservation? Y N (
select one)
A copy of the official rental car receipt must be submitted with the TR support documentation after the travel is completed.
Be Advised:
•
Only WSU employees are allowed to rent and/or drive a car using the State Hertz Rental Car Agreement. Keep your
receipts for
fuel and claim the expenses on Travel Reimbursement (TR) report after the trip is completed.
Insurance Notices:
• Collision Damage Waiver Insurance coverage is included on Wichita State University bank card(s) at no additional cost for
most vehicles. Do not purchase this as additional coverage.
• Personal accident insurance (PAI), personal effects insurance (PEI), and other supplemental liability insurance are considered
personal expenses and are not reimbursable.
•
Out-of-State rental, liability damage waiver and collision damage waiver insurance are reimbursable.
• Additional information on vehicle insurance can be found at: www.da.ks.gov/fm/cmp/information/transition/insurance
Financial Operations – Rental Car Reservation Form 6/26/2015
