Car Rental Agreement

Test Vehicle Rental Agreement

(You will fill this out and sign at time of test in order to rent a vehicle)

Applicant Name: ____________________________________________________________

Customer #: ___________________________ Date of Birth: ________________________

Phone: ________________________________ Email: ______________________________

Vehicle: (Rental vehicle make/model)

Purpose: Vehicle Rental for Behind the Wheel Drive Test

Fee: $30.00

1. CONDITION OF VEHICLE: The Owner states that to the best of her knowledge and belief that above-described vehicle is in sound and safe condition and free of any known defects or faults which would affect its safe operation under normal use.

2. QUALIFICATIONS: The Renter states that he / she is physically and legally qualified to operate the above-described vehicle.

3. INSURANCE: The Renter hereby agrees that he / she shall be held fully responsible for the first $500.00 deductible in case of accident. The Renter agrees that only the vehicle is covered under insurance and the driver or passengers are not covered. The Renter agrees that personal belongings and other items in the vehicle are not covered.

4. The rented vehicle shall not be used for any illegal purpose.

5. The Renter shall not operate the vehicle in a negligent manner.

6. The rented vehicle shall not be operated for any other purpose than use for the behind the wheel drive test.

I agree to all terms and conditions set forth in this agreement.

Date of Rental: _____________________________

Renter: ___________________________________ ______________________________

Print Name Signature

Witness: ___________________________________ _____________________________

Examiner Signature Date