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)
Driver's Full Name:
  First, Middle, Last_____________________________________________
  Street, Town, State_____________________________________________
Driver's License: _______________________ Expiration Date:________
Date of Birth:          ______________________________
Marital Status:         ______________________________
Total No. of Accidents: ___________________ 
Total No. of Violations:___________


Fuel Dispensing Control No. 915.7

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