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Division of Facilities

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Please complete the form below. By submitting this form you agree to the following statement:

DRIVER'S CERTIFICATION: For my protection and the protection of my department, I agree to inspect the vehicle assigned to me BEFORE I leave the parking lot. If I notice any damage or problem with the vehicle, I will have a Motor Pool employee make a note of the damage BEFORE leaving the lot and retain a copy for my department. I agree to remove all debris from inside the vehicle. I certify that I have the valid driver's license listed on this form.

There is a $75.00 charge for lost key/credit cards | State employees ONLY are allowed to drive | Vehicles are to be used for official business only.

If you see this don't fill out this input box.

Driver's information

Driver's name*

K-State email address*

Driver's work phone*

About your travel

Destination*

Number of travelers*

Type of vehicle*

Pick up date and time (mm/dd/yy hh:mm)*

Return date and time (mm/dd/yy hh:mm)*

Authorization and payment

Department name*

Work order*

Phase*

Account number

Collision Insurance*

Yes

No

Driver's certification

Driver's License number*

Driver's License State*

Expiration date*

By submitting this form you agree to the following statement:

DRIVER'S CERTIFICATION: For my protection and the protection of my department, I agree to inspect the vehicle assigned to me BEFORE I leave the parking lot. If I notice any damage or problem with the vehicle, I will have a Motor Pool employee make a note of the damage BEFORE leaving the lot and retain a copy for my department. I agree to remove all debris from inside the vehicle. I certify that I have the valid driver's license listed on this form.

There is a $75.00 charge for lost key/credit cards | State employees ONLY are allowed to drive | Vehicles are to be used for official business only.