Fillable Van-request-2014 Texas Woman’s University

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Van-request-2014 Texas Woman’s University

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Texas Woman’s
University
Van Request Form
Please state below how many vehicles of each type you are requesting (i.e. 1, 2, 3, etc.) fill in all applicable information and send DIRUPIRUHDFK
YHKLFOHUHTXHVWHGWR)DFLOLWLHV0DQDJHPHQW&RQVWUXFWLRQYLDHPDLODWIOHHWVHUYLFHV#WZXHGX
Vehicles require 48 hour notice and keys must be picked up prior to 4 p.m.
VAN______
VAN with special needs_______
Requesting Department: Phone:
Fuel Credit Card Needed: Yes [ ] No [ ] Number of Passengers:______ Estimated travel miles:______
Purpose:
Destination:
Departure Date(s)
Departure Time(s)
Return Date(s)
Return Time(s)
Each person named must provide the Auto Shop staff a valid Driver-Authorization Card along with a valid driver’s license and this
paperwork in order to obtain keys to the vehicle(s) assigned.
A Driver Authorization Card may be requested through Enviromental Health and Safety website.
Driver(s) 1.
Authorization #
Faculty [ ] Staff [ ] Student [ ]
2.
Authorization #
Faculty [ ] Staff [ ] Student [ ]
3.
Authorization #
Faculty [ ] Staff [ ] Student [ ]
_______________________________________________ ____________________________________________________
Requesting Employee (signature) Date Account Approver (signature) Date
Department
Account
No
._________________________
Email Address Required________________________________
DO NOT WRITE IN THE SPACES
BELOW
CONFIRMATION
Approved: Yes [ ] No [ ]
Assigned Vehicles _______________ _______________ _______________
_
_
_ _____________________________________________________________________
Office of Facilities Management Date
Revised 04.04.17
X:/FMC/Central Files/1302/1302.3/1302.3.4
In case of Emergency please call:Dan Knabe 940-465-4090 or Larry Shead 940-783-1479
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Van-request-2014 Texas Womans University

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Completed 3 December 2019

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