University of Hawai`i at Hilo Auxiliary Services/Motor Pool Office
Vehicle Request & Invoice Form
REQUESTING PROGRAM: TODAY'S DATE:
CONTACT PERSON:
PHONE:
EMERGENCY CONTACT PERSON:
PHONE:
REQUESTED PICK-UP DAY/DATE:
PICK-UP TIME:
RETURN DAY/DATE:
RETURN TIME:
DESTINATION/TRAVEL PLAN:
NUMBER OF PASSENGERS:
TYPE OF VEHICLE REQUESTING:
TYPE OF CARGO
AUTHORIZED DRIVERS:
#
FULL NAME
1)
2)
LICENSE#
STATE
EXP DATE
ESTIMATED CHARGES:
- hrs x rate = $
CAMPUS CODE/ACCOUNT CODE
PAYMENT METHOD:
AUTHORIZED DRIVERS ARE DETERMINED TO BE COMPETENT OPERATORS FOR THIS VEHICLE AND WILL FOLLOW THE CONDITIONS AT www.uhh.hawaii.edu/auxsvc/
motorpool/policy.php. I ALSO CERTIFY THERE ARE SUFFICIENT FUNDS TO PAY FOR THIS VEHICLE USAGE.
APPROVING AUTHORITY SIGNATURE TYPED NAME TITLE
FOR MOTOR POOL OFFICE USE ONLY
DATE/TIME RECEIVED:
APPROVED/DISAPPROVED: ASSIGNED VEHICLE LIC #:
INSTRUCTIONS:
INVOICE NO.:
FOR BUSINESS OFFICE
PLEASE PREPARE JOURNAL VOUCHER/PAYMENT TRANSFERRING THE FOLLOWING AMOUNTS FROM THE RESPECTIVE ACCOUNT
INDICATED ABOVE TO THE VEHICLE MAINT.ACCT.#2-2189__(0701)
VEHICLE TYPE ACTUAL HRS. UTILIZED TOTAL HOURS RATE P/HR AMOUNT DUE
Van
Sedan
Handi-Van
$3.00
$1.00
$3.00
