Central Receiving Vehicle Rental Form

University of Wisconsin - Green Bay
2420 Nicolet Drive Green Bay, WI 54311-7001

INSTRUCTIONS:

1. Call Central Receiving to make arrangements for vehicle.
2. Allow 3 days advanced notice.(465-2215)
3. Print this page.
4. Fill out Rental Form and have department head sign and approve. (the budget codes must be filled in for charge back purposes)
5. Record the date, time of departure, and mileage (prior to leaving) on the sheet.
6. Turn form in to Central Receiving when trip is completed.

    Date: ___________________

     UDDS Codes:

Fund	Acct	Unit	Div	Dept	Activity
#	#	#	#	#	#

DEPARTMENT HEAD APPROVAL: (print and sign) ______________________________

                                           ______________________________

DRIVERS NAME: (print)____________________________________________________

PURPOSE OF TRIP:_________________________________________________________

DESTINATION:_____________________________________________________________

VEHICLE CHECKED OUT: Date _________ Time ________ Mileage________________

VEHICLE RETURNED:    Date ____________ Time ___________ Mileage _________

                                                    Total Miles _________

NOTE ANY PROBLEMS OR DAMAGE: ____________________________________________

_________________________________________________________________________ 
Fee Memorandum (PROCEDURE)