Circle of Safety – Pure Broadband

Driver *

Vehicle *

If vehicle not listed, please provide model.

Return mileage *

Any required maintenance? *

Any new damage? *

Vehicle trash emptied? *

Yes

Vehicle secure? (vehicle and compartments are locked and is in assigned parking spot) *

Yes

Gas tank at least half full? *

Yes

Vehicle is stocked? *

Yes

Vehicle is clean inside & out? *

Yes

Acknowledgement

I agree the above information is accurate or to the best of my knowledge. Upon providing false information I may be subject to write up or termination.

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