SD FLEET & TRAVEL MANAGEMENT
DRIVER INFORMATION
CHANGE
FORM
VEHICLE ID:
ODOMETER READING:
CONTACT PERSON:
MAILING ADDRESS:
TELEPHONE NUMBERS:
Street:
Home:
City:
Office:
Zip + four:
Cell:
Location Code:
Fax:
Billing Department
MSA Billing Code
Account Number
ALTERNATE CONTACT:
PHONE #:
IS THIS A NAME CHANGE?
YES
NO
IS THIS AN ADDRESS OR PHONE NUMBER (S) CHANGE?
YES
NO
IS THIS A MSA BILLING CODE CHANGE?
YES
NO
DATE OF CHANGE:
CHANGE REQUESTED BY:
HAVE YOU SIGNED THE RULES & REGULATIONS FORM IN THE SD FLEET & TRAVEL MANAGEMENT POLICY & PROCEDURE HANDBOOK?
YES
NO
IF YOU CHECKED NO – COMPLETE THIS SECTION:
I read and understand the FTM Policies & Procedures for use of a state-owned vehicle in the FTM POLICY PROCEDURE HANDBOOK FOR ASSIGNED DRIVERS & POOL VEHICLES. I agree to abide by these Policies Procedures AND have sent a signature sheet to FTM.
COMMENTS: