Courtesy Vehicle Use Form

Courtesy Vehicle Use Form
Driver's Name*

First NameLast Name
Date and Time of Request*

MonthDayYear
Date
Hour MinutesAM/PM Option
Requesting for Use Until (Please try to limit use to 2 hours)*

MonthDayYear
Date
Hour MinutesAM/PM Option
Aircraft Tail Number*
Insurance Provider*
Insurance Policy Number*
Last Four Digits of Your Driver's License*
Address 1*
Address 2
City*
State*
Zip*
Phone Number*
Email Address
example@example.com
Would you like to be signed up for our monthly newsletter?

YesNo
Rules for Use
1. A minimum of $20 will be charged for any toll fees incurred during use of courtesy vehicle. Non-payment of toll associated fees shall result in revocation of vehicle use privileges.
2. Courtesy car is for patron use. Only the assigned driver shall operate the City of Cleburne vehicle, unless a Courtesy Use Form is filled out by the additional eligible drivers. Driver shall not permit any unauthorized person to operate the City of Cleburne Vehicle.
3. Operator must have a valid Drivers License in his/her possession and be at least 18 years of age.
4. Courtesy vehicle shall remain within the City of Cleburne City Limits and shall be limited to two (2) hours use, unless prior approval has been obtained for extended use.
5. Seatbelts will be worn at all times by all occupants of the City of Cleburne vehicles.
6. Patron shall report any maintenance, fuel needs, or warning indicators to the Airport Associate immediately.
7. Keys will not be left in an unattended vehicle. Doors should be locked for security purposes.
8. Patron will not drive while using a cell phone or handheld device, unless using a hands free system.
9. Patron will not drive under the influence of alcohol or drugs, nor shall alcohol or drugs of any kind be in the city.
10. Every accident/incident involving a personal injury or property damage shall be reported to Risk Management and the Airport Manager immediately. Call 911 if necessary, however do not admit fault of any kind. Insurance certificat can be found in the glove box of the vehicle.
11. No smoking or tobacco products of any kind are permitted for use in the courtesy vehicle.
12. No pets of any kind are allowed in the courtesy vehicle.
13. The patron is to hold the City of Cleburne harmless for any incidents in a city vehicle while in the patron's possession.
By entering your name below, you agree to the above rules and requirements.
Driver's Signature*

Clear
Should be Empty: