Rental Car Application

First name

Last name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Birthday

Month

Day

Year

Company name

Address

Phone

Has your driver's license been suspended or revoked in the past? Enter answer No. Or Yes with explanation.

Have you ever been convicted of a DUI? If so, has it been discharged. Enter Answer No. Or Yes with explanation.

Do you consent to provide a current copy of your MVR? Yes or No

Do you consent to provide proof of income? Yes or No

Do you consent to provide proof of insurance? Yes or No

Do you consent to a background and credit check with Transunion Smartmove at your expense for $48? Yes or No

Do you agree to use vehicle only for Uber or Lyft? Yes or No

Do you understand that the vehicle cannot be used for AmazonFLEX, GRUBHUB, Walmart, Doordash, UberEats, or personal gigs? Yes or No

Do you understand that the vehicle can only be operated in the state of Georgia? Yes or No

Do you agree to forward $350 Deposit upon approval of your rental car application. Yes or No

Signature

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Reference #1 First/Last Name; Address; and Cellphone Number

Reference #2 First/Last Name; Address; and Cellphone Number