Procedure No. 915.6-Supplement 2

Description: Vehicle Accessibility - Driver Summary Form for Insurance Purposes


                       Atlantic Cape Community College
                        Mays Landing, New Jersey
Driver Summary Form for Insurance Purposes
Please complete form FULLY and return to the Facilities Management
Office. (Please print or type)
                                              Date________________
Driver's Full Name:
  First, Middle, Last_____________________________________________
Address:
  Street, Town, State_____________________________________________
Driver's License: _______________________ Expiration Date:________
                      State___________________________
Date of Birth:          ______________________________
Marital Status:         ______________________________
Total No. of Accidents: ___________________ 
Total No. of Violations:___________

Procedures:

Fuel Dispensing Control No. 915.7

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