Vehicle Reservation Request Form
Department ____________________ Org Code ___________
Check out Date ____________ Check out Time ________
Check in Date ____________ Check in Time ________
Trip Type: Campus/Lynchburg Area Day Trip Over Night
(No. of Nights)_______
Name ________________________ Employee Number __________
Email_____________________ Phone Number__________________
Vehicle Type: Car Passenger Van Cargo Van Pick-up Box Truck 14ft
Box Truck 20ft Bucket Truck Flat Bed Truck Other__________________
Total Riders ______
Additional Drivers:
Full Name _________________________ Employee Number ___________
Full Name _________________________ Employee Number ___________
Full Name _________________________ Employee Number ___________
Full Name _________________________ Employee Number ___________
Motor Pool can be reached at Pickup, Delivery, and Drop off Times are to be established with the Motor
Pool Supervisor. All departments are solely responsible for ensuring that requestors are qualified/certified to operate what is being
reserved. Requesting Party is solely responsible for the cleanliness and care of the Asset throughout the duration of the
reservation. Requesting Party is responsible for conducting daily inspections, for monitoring and maintaining all the fluid levels to
manufacture specifications, and refueling throughout the duration of use. If deficiencies are found or the Asset breaks down,
notification must be submitted to Transportation immediately by phone at (434) 592-3248. After 5pm and weekends/holidays,
contact (434)-592-3247. Assets are to be returned completely full of fuel and clean. ALL VEHICLES WILL BE SIGNED OUT AT
THE TRANSPORTATION OFFICE which is located at 3385 Candler's Mountain Road, Lynchburg, VA, 24502. Any damage or
accidents that occur are to be reported to LUPD immediately for a Non-Criminal Property Damage Report. If damage or accident
occurs off Liberty property, local law enforcement will need to be contacted immediately as well as LUPD upon your return. All
Requests are subject to review and may be approved or denied by Management. For any further questions, please see the Motor
Pool Policy. Failure to meet the above requirements will result in financial liability to the requestor’s department and Reservation
privileges may be suspended.
The undersigned agrees to the statement listed above.
Requester or Supervisor Signature _________________________________Date ____________
*Required for request of 3 days or more
Director/ Manager Signature _____________________________________ Date____________
*Required for request of 5 days or more
Vice President/ Dean Signature ___________________________________ Date __________
*Please return this form to for processing upon completion.
Motor Pool Use Only
M/P Rep. Int.:_________ Date:________ Trans. Mgr. Int.:_________ Date:________ F/M SVP. Int.:_________ Date:
click to sign
click to edit
click to sign
click to edit
click to sign
click to edit