University Motor Pool Trip Ticket

University of Colorado at Colorado Springs

Please Read Motor Pool Information

In each vehicle there is a small blue zippered pouch which contains a Wright Express Credit Card and a list of gas companies that accept the card.  On the dash near the odometer you will see the pin number (2120) needed for refueling.  You are no longer required to fuel at the end of a trip but may need to do so on a long trip.  The Wright Express Credit Card is only to be used for the purchase of regular fuel, a quart of oil or windshield washer fluid as necessary.  Before fueling be sure the station accepts this credit card.  If you do not see the emblem on the pump, enter the station and ask first.  If you should have a problem with a motor pool vehicle during normal working hours, 8 AM-5PM, call 719-337-8017 for assistance.  If nobody answers call 719-255-3111 (UCCS Police Dispatch) and have them contact the Transportation Manager for assistance.

Purpose of Trip ________________________________________   Speed Type#_______________

Bumper number _____________  Trip To____________________  Department_________________

Check Out

Odometer____________               Time _________                Date ____________

Check In

Odometer____________               Time _________                Date____________

 

As Driver of the Vehicle Listed Above, I certify it Was Used for University Business

Driver (print)_______________________________________  Drivers License #____________________________

Drivers Signature___________________________________  Date____________

Charges Authorized By _____________________________    Date____________

Please List Any Defects You Noticed While Driving This Vehicle_____________________________________

_____________________________________________________________________________________________

Please Do Not Write In This Space

_______ Miles at  _____ Per Mile_______             =_________

_______Flat Rate Per day  ____  Days                  =_________

                                                 Total Charges                  =_________

Speed Type #__________             Account#700100     TT#________