Truck Rental Agreement
Make of Car_________Color_________Year_________Tag_________
Date Out____________Time Out______________Date Due In______
Date In__________Time In______________Extra Hours _________
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________
Gas in car when rented: 1/4 1/2 3/4 Full
By his [or her] 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.
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.
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.
Continuation of 5054
LESSEE PAYS FOR PETROL/DIESEL
The vehicle described above shall not be operated by any other person than the Lessee who signed the rental agreement or his [or her] employer or by persons regularly employed by such Lessee in the usual course of his [or her] business or an adult member of his [or her] 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.