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Fleet Pool Request
This form has been modified since it was saved. Please review all fields before submitting.
Date
*
Requesting Department:
*
Type of Vehicle Request
*
Automobile
Pick Up
Van
SUV Small
SUV Large
*
Travel Within Nassau County
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
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