Form Test Page - First Baptist Church Brookhaven

Today's Date*

Please reserve the church:*

Bus
Van
10' Enclosed Trailer
16' Flatbed Trailer

Church Ministry:*

Date transportation is needed:*

Time needed:*

Date transportation is returned:*

Time returned:*

Destination:*

NUMBER OF PASSENGERS EXPECTED:*

Will the traveling party need access to bathroom facilities prior to departure?*

Yes
No

Will the office copier need to be used prior to departure?*

Yes
No

I agree to abide by the policies of the Transportation Committee of First Baptist Church as to the use of this vehicle. I further agree to assume the responsibility of this vehicle while in my care.

On request for the BUS/VAN, I understand the cost incurred is computed at the rate of 50¢ per mile for the van and $1.00 per mile for the bus. Please indicate the method of payment:

Money has been budgeted and approved for this trip.
Money will be paid in cash upon return from trip at above rates.

Charge:*

(Name of organizational account budgeted)

Bus / Van Driver

Name of person submitting request*

First Last

Email*

Phone*

Signature*

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Approved by

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Date

Bus / Van / Trailer Request Form - June 2025