Application for Permanent Assignment of Passenger Vehicles

Application for Permanent Assignment of Passenger Vehicle

Person Assigned to or Responsible for the Vehicle

Name:

* *

Drivers License No.:

*State Driver's License Issued From: *

Position Title:

Work Phone No:

Ext: **

Work Mailing Address:

*(if working from home, enter home address)

Work City:

* Zip: *Courier/MSC:

Email:

* *

Vehicle Usage:

Department or Institution Information

Department:

* *

Company:

* Fund No.: * Agency Management Unit: * Agency Program: Funding Source: Project:

Division, Office or Agency Information

Name:

Phone No:

Ext: * *

Address:

City:

* Zip: Courier/MSC:

Address Vehicle Will be Parked:

* City: *

County Vehicle Will be Parked:

Additional Information

Section(if applicable):

District(if applicable):

Vehicle Needs

Date Needed(mm/dd/yyyy):

* *

How Long Needed:

Expected Yearly Mileage Use:

Why Vehicle is Needed and
How it Will be Used:

Type Vehicle Needed: