Time Off Request

Time Off Request
Sales Rep Name: *
Route #: *
Email Address: *
Phone Number

Area Code Phone Number
This request will be authorized by management. You will be notified if this request is approved or denied. Time off is granted on a first come first serve basis. Please be aware that you are not guaranteed the time off. In the rare event of an emergency, your time off may be denied or cancelled.
Today's Date:

Month Day Year
First Day Off:

Month Day Year
Last Day Off:

Month Day Year
Date Return:

Month Day Year
Total # of days requested:
Reason for Request:

Vacation Sick/Personal Day Funeral Leave Jury Duty Other
Comments:
ATTENTION: PRINT a copy for your records before sending. Form will NOT email you a copy. Please dismiss if form tells you it was received as spam. * Items are required to submit the form.
Should be Empty: