VEHICLE REQUESTUSE FORM [PRESS THE TAB KEY TO

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Vehicle Request/Use Form

[Press the TAB key to move from field to field] [Do NOT use the ENTER key]

E-MAIL COMPLETED FORM TO: [email protected]

Please check which vehicle you are requesting: Van Bus

Requesting Individual: Date:

G/L Account Number: Date Needed:

Departure Date: Time: Return Date: Time:

Destination:

Purpose of Trip:

Driver’s Name:

If the vehicle is being requested in conjunction with a Request for Out-of-District Travel, please include this form with that request. All forms must be returned to the Maintenance Office.

VEHICLE REQUESTUSE FORM [PRESS THE TAB KEY TO

Trip Miles
Ending Odometer
Beginning Odometer
Total Miles
Total Spent on Gas	$
Do not forget to record the mileage!

OFFICE USE ONLY
	Caravan 00
	Caravan 22
	Caravan 55
	Bus

Note

Copy of driver’s license and current proof of insurance must be on file with the Facilities Director

If ASU Mid-South is closed upon your return, please park the vehicle in front of the Maintenance Building and return the keys and packet the next working day.

All persons driving or riding in state vehicles are required by state law to wear seat belts. All accidents regardless of severity must be reported in the following order: 1. Police 2. If ASU Mid-South is closed, the drivers should report all accidents to Bancorp South Insurance Services Monday-Friday 8:00 a.m.-4:00 p.m. Accident and Claim Reporting: 501-664-7705 – After hours Accident and Claim Reporting: 501-664-9252. Please report any maintenance or other related problems on the back of this form. A copy of the vehicle registration and insurance card can be found in the glove box.

PLEASE FILL GAS TANK AND CLEAN THE VEHICLE BEFORE RETURNING IT. THANK YOU!

VEHICLE REQUESTUSE FORM [PRESS THE TAB KEY TO

Approvals

VEHICLE REQUESTUSE FORM [PRESS THE TAB KEY TO

NOTE: A “Field Trip/Parental Permission/Medical Waiver” form MUST be completed and on file before a student rides the bus or goes on a field trip. The “School Bus Trip Attendance Sheet” form MUST be completed and returned to the Maintenance Department before the bus leaves ASU Mid- South.

Revised 10/12/17

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