SA State Car Reservation

VEHICLE USE RECORD
All Drivers must possess a valid operator's license. Seat belts must be used, and speed limits observed.
PERSONAL USE EXPRESSLY PROHIBITED

Name of Driver:

Passengers (If any, list names)

Requester's FAU email:

Requester's Cell Phone Number:

Requester's Office Phone Number:

Division of Student Affairs Vehicles:

Date Requested:

Date & Time of Departure:

Date & Estimated Time of Return:

Destination & Trip Purpose

Affiliation:

Department

Student Government Only

Department Name

Required

As the requester/driver of the vehicle, I accept responsibility for leaving the vehicle clean upon the returning of keys.

Required

As the requester/driver of the vehicle, I will wear seat belt and observe speed limits.

Required

Complete vehicle log prior and after return (Vehicle logs are maintained for audit purposes).

Required

Follow all policies/procedures for state vehicle usage by Division of Student Affairs.

Current Drivers License

Signature

All personal items, food, waste, etc. must be removed upon time of return. The Division of Student Affairs is not responsible for lost or damaged items left in the vehicle. Keys are to be presented upon time of return, unless coordinated otherwise.