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Fleet & Travel Management

Vehicle Assignment - Replacement Form

Fill in the following information and click the Submit button to submit the request to Fleet & Travel Management.

Space
Driver Information
Name
* Required
Mailing Address
* Required
Office Telephone Number
Home Telephone Number
Fax Number
Department Name
Department MSA Center Number - Account Number
-
Contact the fiscal officer if you do not know the Account Number.
Space
Submitter Information
Name
* Required
Email Address
* Required
Space
Other Information
City where vehicle will be located
* Required
Average miles driven per month
* Required
Number of passengers in vehicle most of the time
* Required
Existing vehicle license number ( i.e. AC212, CH212 )
* Required
Odometer reading on existing vehicle
* Required
Type of vehicle requested ( sedan, van, 1/2 ton pickup, 4x4 )
* Required
Kind of equipment carried in the vehicle
* Required
Type of road terrain the vehicle will be travelling on
* Required
Explanation of the need for a replacement vehicle
* Required