HWS: Van Pool Request Form

VAN POOL REQUEST FORM

Note: Vehicles are scheduled on first come, first serve basis. Please plan ahead when reserving vehicles.

CHARGES:

If the total round trip mileage is LESS than 100 miles: the rates for vehicle use are $20/half day (4 hours or less) or $40/full day (over 4 hours)
If the total round trip mileage is MORE than 100 miles: a rate of $.40 per mile will be charged. This will be in lieu of the half day or full day charge.
Cleaning Charge: If a vehicle is returned with dirty interior, a $20 cleaning charge will be charged to the department or organization.
Fueling Charge: All vehicles are to be returned full of gasoline. Failure to comply will result in a $50 change to your department.
Your department will be charged for any damage to the vehicles, up to a $1,000 deductible. Vehicles are checked between all trips and any damage found will be noted. It is your responsibility to check the vehicle before leaving campus and to inform the Conferences and Events Department of any damage not listed before you use the vehicle.

Please Check One:	New Request Cancellation Change
Number of Vehicles Needed:	Mini Van (7 person) Van (12 person)
One Time (Daily) Use:
Leave Date: Return Date:
Leave Time: Return Time:
Weekly (Long Term) Use:
Leave Date: Return Date:
Leave Time: Return Time:

Destination/Event Name:
How many passengers are you expecting?
Will you need extra space for equipment or baggage?	yes no
Please note that the vans do not have a lot of storage area behind the back seats, but can usually hold smaller items (i.e. backpacks, etc.) under the passenger seats. Please keep this in mind when scheduling the proper size of vehicle.
Will you need a 12-person van with a trailer hitch?	yes no
Driver's Full Name:
Name of staff or faculty member accompanying this trip:
Department to be charged:
Department Account Number:
Name of Person Requesting the Vehicle:
Phone Number of Requestor:
Phone Number of Driver:
E-mail of Requestor: