Office of Risk Management

Vehicle/Equipment Use Authorization Form

VEHICLE/EQUIPMENT USE AUTHORIZATION FORM
UNIVERSITY OF WISCONSIN - _________________________

SECTION A: VEHICLE USE

Borrower: Name_____________________________________________________________
Title_________________________________ Dept. ________________________
Agency___________________________________________________________
Date(s) of Use: ____________________________________, 20_____

Purpose of Use: ______________________________________________________________

Borrowed Vehicle:

Year Make Model Serial/Vehicle Number
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

Condition of Equipment:________________________________________________________

Driver:
Name________________________________________________________________
Address______________________________________________________________
Driver's License #_______________________________________________________

PLEASE SIGN BELOW

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SECTION B: EQUIPMENT USE

Borrower:
Name_________________________________________________________________
Title_________________________________Dept._____________________________
Agency________________________________________________________________

Date(s) of Use: _______________________________________, 20___________

Borrowed Equipment:

Quantity Description Make/Model Serial Number Estimated Value
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

Condition of Equipment:______________________________________________________________

Security Arrangements made by:_________________________________________________

PLEASE SIGN BELOW

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___________________________________________________________________________________________
Owner's Signature Title Agency Date

____________________________________________________________________________________________
Borrower's Signature Title Agency Date