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:

Account Fund Organization Program Sub-Class  Budget Year Project
             

DEPARTMENT HEAD APPROVAL: (print and sign) ______________________________

                                           ______________________________

DRIVERS NAME: (print)____________________________________________________

PURPOSE OF TRIP:_________________________________________________________
DESTINATION:_____________________________________________________________
(Note: Mileage does not need to be reported if truck stays on campus)
VEHICLE CHECKED OUT: Date _________ Time ________ Mileage________________
VEHICLE RETURNED:    Date ____________ Time ___________ Mileage _________
                                                    Total Miles _________
NOTE ANY PROBLEMS OR DAMAGE: ____________________________________________
_________________________________________________________________________ 
Fee Memorandum (PROCEDURE)