Volunteer Vehicle Use Application

Volunteer Vehicle Use Application

Please fill out the following form if you will be using your own vehicle to transport clients of Catholic Charities.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Driver's License Number
Vehicle Information
Vehicle Year*
Vehicle Make*
Vehicle Model*
Vehicle Identification Number*
License Plate Number*
State *
Expiration*
Owner Information
Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Phone Number*
Automobile Insurance Company*
Agent's Name*
ACKNOWLEDGMENT

IN CASE OF AN ACCIDENT, THE INSURANCE ON THIS VEHICLE WILL BE THE PRIMARY COVERAGE. IT IS

EXPECTED THAT ALL PASSENGERS WILL ADHERE TO STATE SAFETY BELT LAWS AND REGULATIONS. IT IS THE DRIVER'S RESPONSIBILITY TO ENSURE THIS POLICY AND HOLDS THE LIABILITY.

This certifies that all the information given is true and complete and that to the best of my knowledge the vehicle is currently in safe operating condition. / understand that / must be 21 years of age or older, possess a valid driver's license, have the proper and current license and vehicle registration, and have the required insurance coverage in the effect on any vehicle used to transport others. / agree that / will refrain from using a cellphone or any other handheld electronic device while driving my vehicle.
Signature

Clear
Today's Date

MonthDayYear
Date
Should be Empty:

Vehicle Information