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 CREDIT 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)_____________________________________________