Vehicle Rental Registration Form

* indicates required fields

University Contact Information

• First Name: *
• Last Name: *
• Title: *
• Department: *
• Telephone: *
• Fax:
• Western Email Address: *

Reason for Renting the Vehicle

• Specify Activity: *
• Destination (City): *
• Rental Start Date: *
• Rental End Date: *
• Please list the names of all known passengers:

Driver's Information

• Primary Driver's Name: *
• Secondary Driver's Name:

(Note: For you own records, print this page before you click Submit)