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November 25, 2017
TAB Rental Agreement
Step
1
of
7
14%
Today's Date
MM slash DD slash YYYY
Renter's Info
Renter First and Last Name
As shown on your Driver's License.
Home Address
This is where the rental car will be garaged at night.
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mobile Phone
Email
Driver's License Number
State
Expiry Date
MM slash DD slash YYYY
Please take picture of your Driver's license and attach it.
Max. file size: 10 MB.
Social Security Number
Date of Birth
MM slash DD slash YYYY
Personal Reference
Name of a person who can vouch for you.
Phone Number of your Personal Reference
Employer Info
Name of Business
If you're unemployed, please list your source of income.
Supervisor's Name
Supervisor Phone Number
Employer's Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Questionnaire
Has your driver's license been suspended or revoked during the past three years?
Yes
No
Have you ever had a DUI, DWI or any alcohol related arrests?
Yes
No
Have you ever been denied insurance or had a policy cancelled?
Yes
No
I 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
No
QUALIFICATION GUIDELINES AGREEMENT
All 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 control
Assignment Info
Date of Accident
MM slash DD slash YYYY
Insurance Company
This is the insurance company of the at fault driver who hit your car.
Claim Number
Location of Accident
Street / City
Police Report Number
Name of Negligent Driver
This is the person who hit your car.
Your Vehicle
Make and Model of your Vehicle
Vehicle Identification Number
The VIN# of your vehicle.
Proof of Ownership
Title, 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 Company
Insurance Company
Policy Number
Original Issue Date
MM slash DD slash YYYY
Expiration Date
MM slash DD slash YYYY
Picture of Insurance Card
Max. file size: 30 MB.
I HAVE THE RENTAL CAR INFO
Rental Vehicle
Vehicle Rented
VIN or Tag Number
Vehicle Identification# of rental vehicle
GAS Out
E
1/8
1/4
3/8
1/2
5/8
3/4
7/8
F
Date Out
MM slash DD slash YYYY
Rental Fees Per Day
Signature
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.t
Renter's Signature
Name
This field is for validation purposes and should be left unchanged.
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