Van Reservation Request

Department or Organization *
Contact Person * First Last
Phone Number * - (###) - ### ####
Email *
Qualified Van Driver *

Please enter the name of the person who will be driving the van. All drivers must have a current driver application on file with the College. Go to myDiplomat, about Me to check your status. You must complete the driver certification class in order to drive a 12 passenger van. FOR MORE INFORMATION PLEASE REVIEW THE VEHICLE SAFETY POLICY AT http://www.fandm.edu/vsp
Destination City and State *
College Account Number to be Charged
Note: This must be a valid College account. Note: Account numbers changed as of July 1, please make sure you use the correct account numbers. *
Van Size * 7 passenger mini-van 12 passenger van
Start Date (click on the calendar icon) * / MM / DD YYYY
Pickup Time * : HH MM AM/PM
Return Date (click on the calendar icon) * / MM / DD YYYY
Return Time * : HH MM AM/PM
Comments or Additional Information
Emergency Contact Information: * First Last
In the case of an emergency such as a vehicle breakdown, please provide the names and numbers of 2 emergency contact persons that would be willing to come and pick your group up, should you need help returning to campus.
Emergency Contact Information: * First Last
Emergency Contact Phone: * - (###) - ### ####
Emergency Contact Phone: * - (###) - ### ####