RENTAL FORM - Brains Car Rentals

PLEASE USE THE FORM BELOW

DRIVERS INFORMATION - ABSOLUTELY NO DRIVERS UNDER 21 YEARS OF AGE*

Date Field

Full Name*

Phone Number*

Emergency Contact and Name*

Home Address (Street, City, State. Zip)*

E-mail*

ADDITIONAL DRIVERS ?*

Additional Drivers Name

Additional Drivers Phone Number

Additional Driver Lic.#, State, Exp.Date, DOB

Additional Driver Insurance (Policy Number, Agent, Phone)

VEHICLE INFORMATION*

VEHICLE*

Vehicle Gas Control*

incase you need any information please call*

BILLING*

Long Term Rentals (15 days and above)*

Terms and conditions*

Payment Terms*

AMOUNT PER DAY IN USD*

NUMBER OF DAYS*

INSURANCE CHARGE IN USD*

SPECIFY IF ITS 15+ DAYS

DEPOSIT EXTENSION*

TAX (6%)*

DEPOSIT IN USD*

GRAND TOTAL IN USD*

TERMS AND CONDITIONS*