Fill and Sign the Vehicle Authorization Sample Form

REQUEST AND AUTHORIZATION FOR MOTOR POOL VEHICLES Section 1. Instructions. (please read carefully) 1. Fill out ALL spaces on Section 2 of request form. Vehicles should be reserved as far in advance as possible. 2. An itinerary must be attached to this form for ____________________________________ . 3. Send or bring three copies to the Motor Pool Office for scheduling and approval. You will receive an approved copy prior to the trip. 4. Present approved copy to the Motor Pool Office for car and keys. If you are scheduled to leave during non-working hours, you must pick up your keys at __________________ . 5. After completion of the trip, make sure gas tank is full, fill our log sheet (leave in vehicle) and return vehicle to Motor Pool lot in proper place. Return keys to appropriate location. 6. Fill our ALL of SECTION 4 and return the approved copy of this form the Motor Pool office. Return the courtesy card and all gas receipts to the ________________________ . Section 2. Requesting Party must complete this entire section 1. Requesting vehicle use for a trip to: ____________________________________ . departing at ____________ (a.m., noon, p.m., mid), __________________ , 20 ______ and returning at ____________ (a.m., noon, p.m., mid), __________________ , 20 ______ . 2. Number making the trip: ____________________________________ . 3. Purpose of the trip: ________________________________________________ 4. Approved by: ____________________________________ Signature: ____________________________________ Section 3. Office use only Vehicle No. ____________________________________ Signed: ____________________________________ Section 4. Mileage Record Odometer Reading: Ending Mileage: __________________ Beginning Mileage: __________________ Trip Mileage: __________________ Comments: ____________________________________________________________