WIU Car Request - Macomb Campus
Transportation Services: (309) 298-1100
From Location (Campus)
*
Macomb
Quad Cities
Contact Person
*
First Name
Last Name
Contact Phone
*
Format: (000) 000-0000.
Contact Email
*
example@wiu.edu
Trip Details
Date Needed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Date Returning
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Driver
*
First Name
Last Name
Destination
*
Estimated Miles
*
(may be +/- due to actual usage)
Purpose of Trip
*
Limit 50 characters
Vehicle Type
*
Please Select
Car
7P Minivan
Cargo Van
12P Van
15P Van
Mini-Bus
Vehicle Type
Please Select
Standard Car (VW Jetta or similar) - $34
Full Size Car (Chevy Malibu or similar) - $36
5P Standard SUV (Ford Edge or similar) - $56
7P Van - $59
15-P Van - $100
# of People
*
Department
*
Billing & Approval
Account #
*
Fiscal Agent Name (who this request is approved by)
*
First Name
Last Name
Fiscal Agent Email
*
example@example.com
Car Request Email
example@example.com
Special Instructions or Requests
Submit
Should be Empty: