Categories CAR RENTAL APPLICATION TAB Rental App Step 1 of 9 11% Today's Date Date Format: MM slash DD slash YYYY RENTER INFO Renter First and Last Name As shown on your Driver’s License. Garaging Address This is where the rental car will be parked or stored at night. Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mobile Phone Email Driver's License Number State Expiry Date Date Format: MM slash DD slash YYYY Social Security Number Date of Birth Date Format: MM slash DD slash YYYY Personal Reference Name of a person who can vouch for you. Phone Number of your Personal Reference ATTORNEY INFO Which law firm referred you to us? Contact person at law firm Contact person phone number Contact person email EMPLOYMENT INFO Employer If you’re unemployed, please list your source of income. Supervisor's Name Supervisor Phone Number Employer's Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code QUALIFYING QUESTIONS 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 I'm the owner of the vehicle involved in the accident. No Yes 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 10. I am the owner of the vehicle involved in the accident CLAIM INFO Date of Accident Date Format: MM slash DD slash YYYY Insurance Company This is the insurance company of the at fault driver who hit your car. Leave blank if unknown. Claim Number This is for the claim filed with the at fault carrier. Leave blank if unknown. Location of Accident Where did the accident occur? Intersection, street, and City. Police Report Number Name of Negligent Driver This is the person who hit your car. Name of Adjuster Leave blank if unknown. Phone Number of Adjuster Leave blank if unknown. YOUR VEHICLE Damaged Vehicle Year Make and Model of your Vehicle. Vehicle Identification Number The VIN# of the damaged vehicle, if unknown enter license plate number. Ownership Status Own outright (No Liens) Financing Leasing Other Who is the Lien-holder / Finance or Leasing Company Other – Explain YOUR INSURANCE INFO This is the company you pay premiums to . Do you currently have liability insurance? Yes You must be a named insured or a listed driver. Your Insurance Company This is the company you pay monthly premiums to. Your Policy Number Original Issue Date Date Format: MM slash DD slash YYYY Expiration Date Date Format: MM slash DD slash YYYY I HAVE THE RENTAL CAR INFO BY CLICKING NEXT, I AGREE TO THE FOLLOWING: 1- THERE’S A $500 PENALTY IF I SMOKE IN THE RENTAL VEHICLE 2- I WILL BE THE ONLY DRIVER OF THE RENTAL VEHICLE Rental Vehicle Make & Model of Vehicle Rented Tag Number License Plate Number of Rental GAS Out E 1/8 1/4 3/8 1/2 5/8 3/4 7/8 F Date Out Date Format: MM slash DD slash YYYY Rental Fees Per Day Uploads & Signature Please take picture of your Driver's license and attach it. Picture of Insurance Card Proof of Ownership Copy of the title, registration or some proof that you own the car that was involved in the accident you’re assigning to us. 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. Renter's Signature
TABCO LLC Vehicle Rental Solutions | Atlanta, GATABCO LLC Vehicle Rental Solutions | Atlanta, GA