(2)_Attachment_B_Short_Form.doc

Contractor & Visitor Badge Request (Short Form-Less Than 90 days)

NAME:

(Last Name)

(First Name)

*Drivers License #: ________________________

*State of Issue: _______________

Name of Company:

Government Point of Contact:

Phone Number:

Length of Stay (Less than 90 days):

Destination on Depot:

Expected Arrival Date and Time:

*Notes:

If individual will be driving a vehicle on the depot, they need to bring a current driver’s license, current vehicle registration and current insurance card for the vehicle. Vehicles without this information will NOT be allowed access to the installation.

If badges need to be renewed, a request must be submitted by the Government Point of Contact. Without proper paperwork, badge requests will not be honored.