Vehicle Assignment Request Form
Department: __________________________ Org Code: ___________
Vehicle Class: Car Van Pick-up Straight Truck Box Truck UTV
Other ___________________
Vehicle Type: Passenger Cargo Utility
Special Purpose ________________________
Vehicle Grade: Light Duty Commercial Other _________________
Vehicle Rating: 1500 2500 3500 4500 5500
Other ________________
Estimated Weekly Miles Driven: ______Expected Weekly Trips: ________
Estimated Weeks Used in a Calendar Year: __________
The intended purpose of the vehicle, and how it will benefit the department.
Supervisor Signature __________________________________ Date ________
Vice President/ Dean Signature __________________________ Date
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