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Authorized By


									                                TRANSPORTATION Services IET Billing From
Area        ATH      Org                 Sub Org
Purpose Of                                          Sub
                                                     Obj                                               Obj  Sub
Travel:                                             Obj                                                     Obj
                      Team Travel Out of State 7621   30                    Team Travel In State       7611   30
                      Recruiting Out of State  7656   30                    Recruiting In State        7655   30
                      Personal Travel Out of   7620   30                    Personal Travel In         7610   30
                   State                                                 State
                      Official Visit           7545   30

Authorized By                                              Request Date
Billing P.O. Box                                           Phone Number

                                                   Trip Information
Depart Date                                               Time                           AM        PM
Return Date                                               Time                          AM         PM
Type of Vehicle               Sedan           Mini-Van          Mid-Size SUV                  Number of
                              Large SUV              12 Pass Van      Outside Rental   Bus    Passengers
Vehicle #                  (Contact TSC @ 3-2469 for Vehicle #)           Van Cards          Yes

                                               Driver’s Certification
 The Undersigned has read and understands the policies set forth by NAU and the State of Arizona on the
                                   PROPER use of State vehicles.
I understand that it is my responsibility to ensure the compliance of the above mentioned policies. I further
sign knowing that State statutes require the possession of a valid operator’s license to operate ANY state-
owned vehicle and therefore certify that I possess the license listed below.
Driver Name

Driver Phone #

Driver’s Signature

Driver’s License #

Charges                Units                          Rate                      Debit Amount       Credit Amount
Miles Traveled                                        $                         $                  $

Daily Use Fee                                         $                         $                  $

Other Fees                                            $                         $                  $

Odometer               Out                            In
                                                             Totals             $                  $

                                                                                IET Number:

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