Logistical Services

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LOANER VEHICLE REQUEST FORM

Click here for a printable form.

The availability of loaner vehicles is limited. Therefore, vehicles are provided on first come, first serve basis.

A $50.00 CHARGE APPLIES ON ALL REQUESTS THAT HAVE LESS THAN 24 HOUR CANCELLATION NOTICE

DRIVER OF LOANER VEHICLE MUST BE A UMDNJ EMPLOYEE PLEASE COMPLETE FORM AND E-MAIL OR FAX TO LOGISTICAL SERVICES @ 2-3778

After 4:30PM for any concerns, please contact Matthew DeKok: (973) 725-7260

E-mail

Vehicle #:

Date Vehicle Out:

Destination:

Date Vehicle Returned:

Driver’s Name:

Number of days vehicle is requested:

Purpose of Trip:

Department:

Index #:

Telephone:

Department head name:

Department head telephone number:

Cost per day:

NOTE: The above stated driver is authorized by Logistical Services to operate this vehicle to be used for University Business Only for the department noted above. Unauthorized or personal use of this vehicle shall result in disciplinary action up to and including termination.

I confirm that I have a current, valid NJ Driver's License, listed “In Good Standing”. Please fax a copy of the designated driver’s license to Logistical Services, 2-3778.

UMDNJ Employee (driver of loaner vehicle) Information:

Name:
Male Female
Home Address:
Date of Birth:
Eye Color:
NJ State Driver License #:

In the event of an accident or breakdown, please call Logistical Services immediately @ (973) 972-4573/4060. After hours, contact Matthew DeKok: (973) 725-7260

NEW JERSEY STATE LAW REQUIRES SEAT BELTS TO BE USED AT ALL TIMES WHEN UTILIZING THIS VEHICLE. SMOKING IS PROHIBITED IN ALL UMDNJ VEHICLES.

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