VEHICLE REQUEST FORM

VEHICLE REQUEST FORMCOMPLET FORM IN ITS ENTIRETYGENERAL INFORMATIONName of Department:Requestor's Name: Florida Tech ID #:Local Address:Phone #:E-Mail:VEHICLE USEDeparture Date: Time: Returning Date: Time:Approx. Mileage: Number Of Passengers:Purpose of Use (Be Specific) And Destination:Index: Fund.: Org: Prog: Actv. Code:Department Approval Signature:Date:ADDITIONAL DRIVERS INFORMATIONDriver #1: Signature: Date:Driver #2: Signature: Date:VEHICLE CHECKOUTGas Tank (Mark Level): E ' ' ' ' ' ' ' '1/2' ' ' ' ' ' ' 'FCurrent Mileage:Any Exterior Body Marks? YES NO (If Yes, indicate damage on attached body sketch sheet)Interior Condition: Clean Dirty (If dirty, be specific in the comments field below)Comments:OFFICE USE ONLYApproval:Debit:Gas Credit:Date:Gas Cost:Daily/Weekly Charge: Mileage Credit: Mileage Cost:Date of Departure: Time: Odometer Reading:Date of Return: Time: Odometer Reading:Miles Driven: Gallons of Gas Used: X $ = $Signature of Transportation Department:Updated 8/13/08

1. An Advisor or another member of the faculty, staff or administration must accompany allapproved, funded travel outside the state of Florida.2. Any tickets, (Moving violations, parking violations or otherwise) given by police or campussecurity, are the sole responsibility of the driver of the vehicle. Organization funds will notbe used to pay for tickets or fines.3. The van must be returned CLEAN.VAN POLICY4. It is the responsibility of the driver to inspect the van prior to accepting the keys. If there areany body damages (Dings, dents, etc.), please fill in the Body Damage section of theCheck-In / Check-out Form. If the body damages exist before departure, you must specifythis on the van form. Damages that occur after departure, or those that are unaccounted foron the form, may become the responsibility of the requesting department.5. All drivers must be authorized by the Financial Affairs Office prior to the trip. Please contactWanda Givens at (321) 674-7340 to become an authorized driver.6. Organizations are not permitted to have copies of the vehicle keys made. If additional keysare required, contact the Facilities Management Transportation Department at (321)-674-7287.DEPARTMENT VAN USE POLICY1. All vehicles will be provided with a full tank of gas. Gas used during the trip will be charged tothe requesting department. Cost of fuel will be based on fuel prices at the time of trip.2. Upon return of vehicles, the Transportation Department and authorized driver will inspect thecondition of the vehicle. Any damages will be charged to the requesting department.3. Only licensed /approved drivers may drive the van.4. The number of people transported in the van must not exceed the recommended occupancylimit.5. No alcoholic beverages are allowed in the van.6. Van must be returned in the condition it was in at pick-up.