PTRWDB Mobile Unit Request Form - PTRC

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

Entity Name
 *
Contact Name
 *
Contact Title
 *
E-mail
Phone
County
Municipality
Department
Department
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 day of event)
 *
Date/Time of Arrival
Date/Time of Departure
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?
Staff assistance is available?
Staff assistance is available?
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’ve read the PTRC Rover Policies and Procedures and understand the Fees associated with my group or organization.
 *
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