Philadelphia Presbyterian Church 11501 Bain School

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Philadelphia Presbyterian Church 11501 Bain School Road Charlotte, NC 28227

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FEE:

APPLICATION FOR USE OF CHURCH VEHICLE PHONE:

PERSON REQUESTING: DRIVER(S): DRIVER(S) PHONE : GROUP NAME: DATE(S) REQUESTD :

NO. OF PEOPLE :

TIME OF DEPARTURE :

TIME OF RETURN :

DESTINATION :

APPROXIMATE MILES: GAS TANK SHOULD BE FILLED BEFORE RETURNING TO CHURCH

This vehicle is being used with the agreement and under the guidelines of Philadelphia Presbyterian Church. Responsibility for use of this vehicle while subject to this agreement lies with the undersigned individual. The requesting group will be responsible for an insurance deductible in the event of fault in an accident. I have read and understand these usage guidelines. Our group will abide by these guidelines during the use of the van. Signed:

Date:

Phone:

(This application must be received by the Building Usage Committee of the Board of Deacons before final approval is given for use of this vehicle. LIST DRIVER(S) BELOW: Driver

License No.

Expiration Date

Do not write below this line. SEC

BUC

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