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:* BH EIV EV EVI Other 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)* 01 02 03 04 05 06 07 08 09 10 11 12 : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 AM PM The time you will pick up the cart Date of Rental (to):* The date you will return the cart Time of Rental (to): 01 02 03 04 05 06 07 08 09 10 11 12 : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 AM PM The time you will return the cart