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Fleet Pool Request

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Date*
Requesting Department:*
Type of Vehicle Request*
1. Automobile
2. Pick Up
3. Van
4. SUV Small
5. SUV Large
*
1. Travel Within Nassau County
2. Travel Outside Nassau County
Estimated Round Trip Mileage*
Pick up Date/Time*
Return Date/Time*
Employee/Driver Requesting*
Brief Description of Use*
Note: Vehicles must be cleaned and filled up upon return if less than 3/4 full
(To be completed by Road & Bridge)
Reservation Approved By
Odometer Reading on Pick Up
On Return
Any Problems With Vehicle Please Describe