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Form last updated:11-2013 Submit form to Operations Services.
EQUIPMENT REQUEST FORM Date:
Light & Medium Duty VehiclesTAB to the next field. SHIFT-TAB to return to a previous field.
Dept FCPS Division Patrol
Domicile/
Dept Code M
Funding year 2020
Budgeted
Amount $486,440.00
Business Unit Acct # 603050.534030
Funded as: Capital purchase Lease Purchase
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Quantity requested: 10 correct check boxes
New
unit Used unit
Describe intended use and reason for purchase: SBFord 343930 (10)
REC 142510 (10)
Anticipated usage: Miles per year: Hours per year:
If this is a replacement unit, which unit(s) will be replaced? Unit # See Below
Model year of unit to be replaced: multiple Current meter reading:
Reason for replacement: 21116, 11104, 11103, 11122, 11108, 11112
Description of vehicle requested:
Item: Make selection using drop-down boxes:
Vehicle Type Suv
Body Style Intermediate
Cab Type N/A
Drivetrain All wheel drive
Engine Standard equipment
Transmission Standard equipment
Fuel Type Gasoline
Added Vehicle Information: Ford Interceptor
Requested options: (power windows/locks, cruise/tilt, towing package, opt. axle ratio)
Enter your requests: REC Upfit Patrol Pkg
Other accessories: (Snow plows, winches, tool boxes, utility body, crane, etc.)
Enter your requests:
Name of contact person in your department:
Name: Phone/email: