The University of Tennessee, Knoxville

Office



Forms Required for Vehicle Purchase

Complete the online form below
Or print this form and fill out by hand; mail to TN Vans.


Sunday August 20, 2017

Your unique identifier is 599a12a97898f

 * indicates required field
Date:*
Agency Name:*
Agency Address:*
Agency Address Line 2:
Mailing Address:*
Mailing Address Line 2:
City:*
State:*
Zip:*
Telephone:*
Alternate Telephone:
Agency Email:*
Agency Website:*
Agency Federal or
Employer ID:*
Director's Name:*

Describe your agency and the population/persons served by your program and estimate approximate numbers served.
Why does your agency need a vehicle? Please explain.
What types of trips are planned for the vehicle? Please explain.
Number of years your agency has been in operation.
Type of vehicle(s) requested.
Passenger Van
(1 driver, 14 riders)
Minivan
(1 driver,   6 riders)
Sedan
(1 driver,   4 riders)
Please list three program references including telephone numbers. Program references include persons who are familiar with your program and your need for vehicles.
a.
b.
c.
Please list three credit references including telephone numbers. Credit references should be able to provide information indicating that your agency meets its financial obligations (i.e. pay accounts on time and account current).
a.
b.
c.
Name and phone number of chief financial officer for invoicing and accounting.
Name
Phone number
What source(s) of revenue will you use to pay for the vehicle.
Rider Fares
Grant Funds
Donations
Other (please state below)
Insurance Agent Name and phone number.
Name
Phone number

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*Please type this number here.


The University of Tennessee, Knoxville. Big Orange. Big Ideas.

Knoxville, Tennessee 37996 | 865-974-1000
The flagship campus of the University of Tennessee System