"*" indicates required fields Vintage Car Rental AgreementVehicle Check Out:* MM slash DD slash YYYY Time Hours : Minutes AM PM AM/PM Vehicle Is Due Back:* MM slash DD slash YYYY Time Hours : Minutes AM PM AM/PM Rental Extension Extension Due Back Date MM slash DD slash YYYY Odometer Reading: @ Check Out @ Check In Car Renter's Name:* Car Renter's Phone Number:*Email: Occupation:* Place of Employment Home Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Driver’s License Number*Issuing City/State:* Expiration Date:* MM slash DD slash YYYY Date of Birth:* MM slash DD slash YYYY Local Address: Emergency Contact Name:* Emergency Contact Phone Number:*Relationship: Place of Employment: Pick a payment option Debit/Credit Card (POS) Wire Transfer: Cash: Other Additional Driver Name: Additional Driver Phone Number:Additional Driver's Email: Additional Driver's Occupation Additional Driver's Place of Employmet: Additional Driver Address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Driver’s License Number: Issuing City/State: Expiration Date: MM slash DD slash YYYY Date of Birth: MM slash DD slash YYYY Car Make: Model: License Plate Number: Upload license front page*Max. file size: 256 MB.Upload license back page*Max. file size: 256 MB.Gas Tank Reading Full ¾ ½ ¼ Less Than Quarter Empty Consent* I agree to the fuel agreement.The individual mentioned above in this Car Rental Contract hereby agrees to fill the fuel tank at the above indicated level upon returning the car. Failure to fill the tank at the prescribed level will result in an additional penalty charge of $2000.00 JMD per quarter tank of gasoline.Consent* I agree to the lost keys agreement.It is the Car Renter’s responsibility for all lost car keys and / or a lockout situation.Consent* I agree to this rental agreement.Only the person(s) that are listed on this Car Rental Agreement and above the age of twenty may drive this vehicle. The above mentioned Car Renter is hereby responsible for all collision damage to the vehicle regardless if someone else is at fault or the cause is not known. The Car Renter is fully responsible for the cost of any repair up to the value of the vehicle. The Car Renter’s Insurance may cover all or only part of the financial liability for the rented vehicle. Car Renter should check with their insurance company regarding their coverage and what they are and are not liable for. Liability Insurance will only be in excess over any and all additional collectible insurance. The above mentioned Car Renter hereby waives all uninsured and under insured motorists, no fault and any other optional additional coverage. If such additional coverage cannot be waived or excluded then the Car Renter agrees that such coverage will be limited to only the minimum state requirements. The Car Renter is hereby bound by the terms and conditions of this Car Rental Agreement. The vehicle must be returned to the same location in which it was picked up for rental and on or before the above indicated due back date and time. There will be additional fees due if the vehicle is not returned as specified above. Where it is permitted by law the Car Renter hereby authorizes us to process their credit card information in their name for all Car Rental charges, including the full vehicle value of any vehicle that is not returned to the Car Rental Company, all fines, towing, any court costs, penalties, and or administrative fees that we may incur for parking, traffic and or other violations that may be incurred by the Car Renter during the Car Rental term period as stated above and to apply any payments made to the charges in whatever order that the Car Rental Company sees as necessary or Car Renter pays by cash. The Car Renter will be charged a safety deposit which is refundable after the car is returned with no incidentals. Incidentals include, scratches, dirty car, damage parts, damaged tires, smoking in the car. The deposit will be held for 2 days after returning the car, then it will be refunded to you if everything is fine. A fine of $4000 JMD will be charged if the car is returned with any smoke scent. Also please note that if a Car Renter reserves a vehicle and pays a safety deposit to reserve the vehicle, the safety deposit is not refundable if the Car Renter cancels the booking. By signing below Car Renter is also signing their Car Rental credit card voucher. Car Renter Signature Reset signature Signature locked. Reset to sign again Date MM slash DD slash YYYY Additional Car Renter Signature Reset signature Signature locked. Reset to sign again Date MM slash DD slash YYYY
