Ministry name:

Name of person/persons driving

1st Person:

2nd Person:

3rd Person:

Cell phone numbers

1st Cell:

2nd Cell:

3rd Cell:

Moving violations in the last year? Yes No (If answered yes to above question, person will not be eligible to drive vehicles)

Time keys are to be picked up. (No sooner than day before.) Date: (mm/dd/yy) Time:

Gas card (VCC Ministries ONLY) Requested? Yes No

If gas card is requested, who will be responsible for its return? Name and phone number: ($25.00 replacement fee).

Departure time. Date: (mm/dd/yy) Time: Return time. Date:(mm/dd/yy) Time:

Destination of vehicle(s):

Number of people traveling? (12 per van max).

Van(s) requested: 111 112 Both

Additional comments:

Available key pick up times are as follows:

Monday - Friday 7am to 6pm (Excluding Thursdays).

Thursday 7am to 3pm

Saturday 8am to 2pm

Sunday 7am to 1pm

*Key pick up will not be available on Nationally Observed Holidays. Please arrange for key pick up accordingly.

*Note: Vans are to be returned clean of visible debris and refueled with all windows closed.

Your ministry will be charged a $25.00 cleaning fee and/or a $10.00 refueling fee plus cost of replacement fuel if above is not adhered to.

Also note that submitting this request does not guarantee the reservation of the van. An email will be sent to you regarding status and availability.