Companytab by Appraisal Engine Inc. on November 25, 2017TAB Rental Agreement Step 1 of 714%Today's Date MM slash DD slash YYYY Renter's InfoRenter First and Last NameAs shown on your Driver's License.Home AddressThis is where the rental car will be garaged at night. Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mobile PhoneEmail Driver's License NumberStateExpiry Date MM slash DD slash YYYY Please take picture of your Driver's license and attach it.Max. file size: 10 MB.Social Security NumberDate of Birth MM slash DD slash YYYY Personal ReferenceName of a person who can vouch for you.Phone Number of your Personal ReferenceEmployer InfoName of BusinessIf you're unemployed, please list your source of income.Supervisor's NameSupervisor Phone NumberEmployer's Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code QuestionnaireHas your driver's license been suspended or revoked during the past three years? Yes NoHave you ever had a DUI, DWI or any alcohol related arrests? Yes NoHave you ever been denied insurance or had a policy cancelled? Yes NoI understand that I'm the only person allowed to drive the rental car. I am also aware that I am required to bring it the vehicle back to the rental office for inspection within 7 days. Yes NoQUALIFICATION GUIDELINES AGREEMENTAll auto rental customers must properly be qualified at the counter prior to renting a vehicle. I hereby declare, promise and agree to the following: 1. I am over 21. My Driver's license is current, not expired, not conditional or restricted in any way 2. I currently carry liability insurance 3. I am receiving a rental and in lieu of payment, I am assigning my loss of use claim to TABCO 4. I will not smoke, soil or dirty the car in any way 5. I don't have more than 3 points on my driver's license 6. I will not drive the vehicle outside of Georgia and will be responsible for any fines or parking tickets issued against the rental vehicle 7. I promise to return the rental vehicle back to TABCO LLC within 24 hours of a return request 8. I understand that a $1,000 lien against my Bodily injury settlement will be placed to cover the deductible of the collision waiver I decided to buy on the rental 9. I will not allow anyone else to drive the rental. I also promise to store it in a safe location and always keep it under my care and controlAssignment InfoDate of Accident MM slash DD slash YYYY Insurance CompanyThis is the insurance company of the at fault driver who hit your car.Claim NumberLocation of AccidentStreet / CityPolice Report NumberName of Negligent DriverThis is the person who hit your car.Your VehicleMake and Model of your VehicleVehicle Identification NumberThe VIN# of your vehicle.Proof of OwnershipTitle, registration or some proof you own the car that was involved in the accident you're assigning to us.Max. file size: 30 MB.Your Insurance CompanyInsurance CompanyPolicy NumberOriginal Issue Date MM slash DD slash YYYY Expiration Date MM slash DD slash YYYY Picture of Insurance CardMax. file size: 30 MB. I HAVE THE RENTAL CAR INFORental VehicleVehicle RentedVIN or Tag NumberVehicle Identification# of rental vehicleGAS Out E 1/8 1/4 3/8 1/2 5/8 3/4 7/8 FDate Out MM slash DD slash YYYY Rental Fees Per DaySignature I acknowledge that: I am the individual referred to in this request and that all of the information that I have provided in this form is true, complete and correct.tRenter's SignatureCommentsThis field is for validation purposes and should be left unchanged.Δ
