PTRWDB Mobile Unit Request Form - Community Based Organizations

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Please correct the field(s) marked in red below:

Entity Name
 *
Contact Name
 *
Contact Title
 *
E-mail
 *
Phone
 *
County
Municipality
Event Type
Event Type
Date(s) for Event
 *
Event location - Please provide name and address of where unit is needed.  
 *
Name of contact person at the event.
 *
Cell phone number for the contact person (for the day of the event).
 *
Date/Time of Event start
Date/Time of Event end
Facilities
Are public toilet facilities available?
(Note:  If not, scheduling entity will be responsible for providing portable facilities.)
Are public toilet facilities available? (Note: If not, scheduling entity will be responsible for providing portable facilities.)
Is secured onsite storage available for the PTRWDB Unit?
Is secured onsite storage available for the PTRWDB Unit?
The Mobile Unit staff will set up and break down the Mobile Unit ONLY. Do you have staff stationed in the mobile unit during your event?
The Mobile Unit staff will set up and break down the Mobile Unit ONLY. Do you have staff stationed in the mobile unit during your event?
Additional Notes:
Billing Office Information
Entity Name
 *
Office Telephone
Payment Method
Payment Method
Billing Address
City/State/Zip
Requisition or Order Number
Request Submitted by:
 *
Yes, I have read the PTRC Rover Policies and Procedures and I understand the fees associated with my group or organization. (Usage and Fees are listed at the top of this page)
 *
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