Vehicle Issuance Form

Vehicle Issuance Form

Please provide the requested information in the fields below to get started.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Group Number (GIN)*
New Vehicle Number *
Reason for pick up:*

New GroupPrimary Driver ChangeUpsize/DownsizeMileage Equalization
New Groups - My signature at the bottom of this form acknowledges that:
- My group's established commute route is accurate to the best of my knowledge.
- My group must inform Pierce Transit of any permanent or temporary changes to our route as they occur.
- Rideshare fares are subject to change based on daily commute miles.
Will you be the public contact for anyone interested in joining your Rideshare? This person's contact information is listed publicly on Rideshare.PierceTransit.org.*

YesNo
If yes, please list the email and phone number you would like to share on Rideshare.PierceTransit.org.
Email
example@example.com
Phone Number
Please enter a valid phone number.
If no, please list the name, email and phone number of the person who will be the public contact for your Rideshare on Rideshare.PierceTransit.org.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Pierce Transit has confirmed that your vehicle is clean and ready to use. Unless otherwise noted, items listed on the Pierce Transit Vehicle Inventory List will be issued with the vehicle.

Please let us know if you see something we may have overlooked, including the cleanliness of the vehicle or missing items listed on the inventory list.
Please enter the odometer reading:*
Does the vehicle have any noticeable damage?*

YesNo
Are the items listed on the inventory list in the vehicle?*

YesNo
Please list any noticeable damage, missing items, or other concerns: *
What did the group receive? (check all that apply)*

KeyRemoteComboKey Card
Key *
Please enter the total number of keys your group received.
Remote*
Please enter the total number of remotes your group received.
Combo*
Please enter the total number of combos your group received.
Key Card*
Please enter the total number of key cards your group received.
Acknowledgements
My signature below signifies that:
- I am receiving the vehicle listed above in the condition stated on this form.
- I agree to return the vehicle in the same or acceptable condition, as determined by Pierce Transit.
Failure to comply with the terms of this agreement may result in termination of your Rideshare group and/or charges for damaged or missing items listed on the inventory list.
Signature*

Clear
This form will not be accepted without a signature.
Date*
Should be Empty: