• Customer Name

  • Address
  • Driver's License Number

  • State

  • Expires

  • Take a photo of License

  • Birthday

  • Telephone

  • E-mail

  • Date Out

  • Date Due In

  • Mileage Out

  • Mileage In


  • Car Rental Rate

  • Gas Tank Reading

  • Miles Allowed

  • Time and Mileage Charges

Car Insurance

  • Insurance Type

  • Auto Insurance Company

  • Policy Number

  • Expiry Date


  • Fuel Policy

  • Additional Driver Fee

  • Total Charge

  • Payment Received

Sign off

  • Car renter (Full Name and Signature)

  • Processed By (Full Name and Signature)

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