Car Rental Form

• Car Rental VIN

• Plate Number

• Year/Make/Model

• Pickup Date

  Date

• Prepared by

• Location
  Address

General

• Customer Name

• Address
  Address

• Driver's License Number

• State

• Expires

  Date

• Take a photo of License

  Media

• Birthday

  Date

• Telephone

• E-mail

• Date Out

  Date

• Date Due In

  Date

• Mileage Out

• Mileage In

Vehicle

• Car Rental Rate

• Gas Tank Reading

  Full

  3/4

  1/2

  1/4

  Empty

• Miles Allowed

• Time and Mileage Charges

Car Insurance

• Insurance Type

  Select Loss damage waiver Liability insurance Personal accident insurance Personal effects insurance Own Auto Insurance

  • Loss damage waiver
  • Liability insurance
  • Personal accident insurance
  • Personal effects insurance
  • Own Auto Insurance

• Auto Insurance Company

• Policy Number

• Expiry Date

  Date

Payment

• Fuel Policy

  Free Tank

  Full to Full

  Pre-purchase

  Others

• Additional Driver Fee

• Total Charge

• Payment Received

  Yes

  No

  N/A

Sign off

• Car renter (Full Name and Signature)

  Sign

• Processed By (Full Name and Signature)

  Sign