Vehicle Request Form

Auxiliary Services reserves the right to assign specific vehicles based on need, destination, & other institutional requirements. Auxiliary Services reserves the right to decline request for vehicle(s) should travel be over 1,000 miles in a trip. If trip will be between 750 - 1,000 miles alternate transportation is encouraged. For trips over 1,000 miles alternative transportation will need to be utilized.

Please Note: Authorized signer for the account must sign; not the requester, unless you are a authorized to sign for the account.

Today's Date Today's Date / MM / DD YYYY
Requester Information
Name Name * First Last
Email *
Phone Phone * - ### - ### ####
Department *
Trip Information
Pick-up Campus *

Pick-up Campus Dahlonega Gainesville Oconee

A pickup campus must be selected
Destination *
Do you certify that this is official University business? *

Do you certify that this is official University business? Yes No
Number of passengers, including driver *
Name of driver(s) *
Have driver(s) taken the safety course administered by Risk Management? *

Have driver(s) taken the safety course administered by Risk Management? Yes No
You have indicated that the driver has not taken the safety course administered by Risk Management. They will need to complete the “motor vehicle training” NLT 48 hours prior to key pickup time listed below in order to be eligible to drive.

If you have questions pertaining to the training, please direct them to Darren Martin in Risk Management at darren.martin@ung.edu
Date of Vehicle Use
Beginning Date Beginning Date * / MM / DD YYYY
Ending Date Ending Date * / MM / DD YYYY
Key(s) Pick-up
Date Date * / MM / DD YYYY
Time Time * : HH MM AM/PM
Vehicle & Key(s) Return
Date Date * / MM / DD YYYY
Time Time * : HH MM AM/PM
Billing & Approval Information
Account to be billed: 719102- *

A departmental account number is required. This number is listed for your department under the chart of accounts. If you need assistance finding your departmental account number please contact your departmental admin as they should be able to provide your account number and name.
Account Name *
Authorization - Department Head Authorization - Department Head * First Last
Electronic Signature - Draw your signature into the box below.
**Authorized signer for the account must sign; not requester, unless you are authorized to sign for the account *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
*

I have read, understand and agree to the Rental Fleet Policy & Procedures

Vehicle Request Form

Vehicle Request Form

Requester Information

Trip Information

Date of Vehicle Use

Key(s) Pick-up

Vehicle & Key(s) Return

Billing & Approval Information