BUS REQUEST FORM

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					       PLEASE FAX OR EMAIL YOUR REQUEST                                     BUS REQUEST                                      PLEASE SEE ATTACHED FILE FOR
       TRANSPORTATION FAX #: X6167                                                                                         RATES AND EQUIPMENT AVAILABLE
       TRANSPORTATION EMAIL: transportation@bnl.gov


                                                                                                                                           TRANSPORTATION USE ONLY
NAME OF GROUP                                                                                                                              PO #:   80455 (BSA FUNDS)
DATE OF    PICK UP                                                                               DROP OFF
SERVICE      TIME                                                   DESTINATION                     TIME
                           PICK UP POINT                                                                         DROP OFF POINT                EQUIPMENT REQUESTED
           (AM/PM)                                (IF THIS IS A SITE TOUR PLEASE GIVE ROUTING)    (AM/PM)




                                                    PLEASE complete the REQUIRED BLUE fields.



       Please make the necessary arrangements with security regarding your function.
REQ'D BY                                   PHONE # OR EXT                                          FAX#                                    EMAIL
TWO (2) LETTER DEPT/DIV CODE               PROJECT ID # (MUST INCLUDE)                                      ACTIVITY ID # (MUST INCLUDE)
     REMARKS


                                                       TRANSPORTATION USE ONLY
  CONFIRMED BY                                                                                                                             DATE
                     This is your confirmation for the above requested service. Please be aware of the cancellation policy mentioned below. Any changes to the above
     REMARKS         mentioned request must be made directly with the Transportation Office at (631) 344-2535 or by email to transportation@bnl.gov or by fax at (631)
                     344-6167.
   RATE QUOTE

                               RESERVATION MUST BE CANCELED TEN (10) BUSINESS DAYS PRIOR TO AVOID PENALTY.
 CANCELLATION POLICY           CANCEL TWO (2) TO NINE (9) BUSINESS DAYS PRIOR - $150.00 PENALTY
                               CANCEL WITHIN 24 HOURS - FULL FEE WILL BE CHARGED