RENTAL AGREEMENT
R.A.
Unit_______
Make of Car_________Color_________Year_________Tag_________
Date Out____________Time Out______________Date Due In______
Date In__________Time In______________Extra Hours _________
Driver's Lic.__________State________Expiration_______Birthdate______
Driver's Name_______________________Home Phone_____________
Home Address_________________________ Rate per Day_________
Local Address________________________ Rate per Week________
Credit Card: Master Charge Diner's Club Mileage Charge___
American Express B.A.C.
Carte Blanche Mileage In_______
Number___________________Expiration______ Mileage Out______
Employed by______________Phone___________ Mileage Driven___
Address__________________________________ Rental Charge____
Renter's Insurance Co.___________________ Mileage Charge___
Renter's Policy__________________________ Collision________
Second Car__________Date______Tag________ P.A.I.Coverage___
Make_______________Color_________Year____ Other Charges____
Reason for Exchange______________________ Sales Tax _______
CUSTOMERS ARE RESPONSIBLE FOR ALL TOTAL DUE________
TRAFFIC VIOLATIONS
Deposit________
Gas in car when rented: 1/4 1/2 3/4 Full
By his initial, Renter accepts/declines Balance Due______
personal accident insurance (PAI) at $1.00
per day. Acceptance is proof of coverage Refund __________
under policy issued as outlined in separate
synopsis. CASH CHECK cREFIT
CARD
Accepted______________Declined ____________
This contract covered with COLLISION DAMAGE WAIVER for which
I agree to pay an additional charge of $2.00 per day. In
event any of the terms of this rental contract are violated,
this clause shall be null and void, and the Lessee shall be
liable to the Company for all damages to the vehicle.
BY________________________________________
I do not want COLLISION DAMAGE WAIVER and accept full
responsibility for all damage to rented car up to $250.00.
In the event any of the terms of this rental contract are
violated, this clause shall be null and void, and the Lessee
shall be liable to the Company for all damages to the
vehicle.
BY________________________________________
Rented by________________________
Recommended by___________________
Continuation of 5054
LESSEE PAYS FOR GASOLINE
The vehicle desribed above shall not be operated by any other
person than the Lessee who signed the rental agreement or his
employer or by persons regularly employed by such Lessee in
the usual course of his business or an adult member of his
immediate family at least 21 years of age.
The Lessee is responsible for theft of car unless keys are
removed and doors locked.
I HAVE READ BOTH FRONT AND REVERSE SIDES OF THIS CONTRACT AND
AGREE TO ALL OF THE TERMS.
Signed (Lessee)_____________________________________________
