Electric Cart Rental Request Form

To request use of the HSSEAS electric cart, please check cart availability first, then complete the following request form.

* indicates required field

Name:*

Requester E-Mail:*

An email address that we can use to contact you

Requester Building:*

Requester Room Number:*

Requester Phone Number:*

Your Phone Number

Authorized By:*

The person who authorizes your use of the cart

Authorization E-Mail:*

The email address of the person who authorizes your use of the cart

Recharge ID:*

The Recharge ID we should use to charge you

Date of Rental (from)*

The date you will pick up the cart

Time of Rental (from)*

The time you will pick up the cart

Date of Rental (to):*

The date you will return the cart

Time of Rental (to):

The time you will return the cart