KU School of Medicine-Wichita: Facilities Management State Vehicle Request Form

Facilities Forms - State Vehicle Request Form

NOTE: All fields are required. Use tab key or mouse to move from field to field. Once you have completed your trip, please fill out our customer report card. Thank you.

Name:

Department:

Campus Address:

Campus Phone:

Billing Account #:

E-mail Address:

Use of State Vehicle

Drivers License #:

Number of Passengers:

Remove extra seats? (if applicable)
Yes No

Purpose of Trip:

Destination:

Pick Up Keys:

Date: Time:

Departure:

Date: Time:

Return:

Date: Time:

Vehicle Type (if available - click on the vehicle to see a photo):

Minivans: 2006 Dodge Grand Caravan 2007 Ford Freestar

Cars: 1994 Pontiac Grand Prix

Cargo Van: 1997 Dodge Ram Van (15 Passenger)

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General Information