Fill and Sign the In Whose Name is the Home Phone Listed Form

- 1 - APPLICATION FOR VEHICLE LEASE AGREEMENT Name: Date of Birth: Address: Apt #: City: State: Zip: Home Phone: Message Phone: In whose name is the Home phone listed: How long at this address: Are you a U.S. Citizen: Yes No National Origin: Height: Weight: Hair: Eyes: Driver's License Number: State: Expiration: Marital Status: Maiden Name: Spouse Name: How did you hear of this Company: Previous Address: City: State: Zip: Place of Employment: Address: City: State: Zip: Work Phone: Supervisor: Occupation: Title: Work Hours: Pay Dates: Monthly Take Home Pay: _ How long at this job: List Four (4) Friends or Relatives as references:Name : Address: Phone: Name : Address: Phone: Name : Address: Phone: Name : Address: Phone: Do you rent or own your home: Rent Own Landlord/Mortgage Company: Address: City: State: Zip Phone: Contact Person: - 2 - VEHICLE LEASE AGREEMENT Today’s Date: _______________ Contract # ______________This Lease Contract is entered into between: ____________________________________________________ and; ___________________________________________, at ___________________________________________ , hereinafter called "the Company", organized and operating under the laws of the State of ___________________________________________.THE PARTIES HEREBY MUTUALLY AGREE AS FOLLOWS:1. DESCRIPTION OF THE PROPERTY: the Company hereby leases to LESSEE and LESSEE hereby hires from the Company, under the terms and conditions herein:Vehicle: Year 20___ Make ____________________ Body __________________ Model ________________Color _________________ VIN: ______________________________________ License ____________ Exp ____2. AMOUNT / TERMS: THIS IS AN OPEN-END LEASE. ORIGINAL VALUE:$ _________________* NO AMOUNT OF THE FIXED LEASE SHALL BE CREDITED TO THE ORIGINAL VALUE.The amount of the fixed rental is $___________________ PER DAY WEEK MONTH YEAR. LESSEE shall pay a late charge of $___________________ per day plus the fixed lease for each day beyond the due date. Each renewal must be done in person with the vehicle present. 3. INSURANCE: LESSEE SHALL PROVIDE, AT HIS OWN EXPENSE, AND MAINTAIN IN FULL FORCE AND EFFECT DURING THE TERM OF THIS CONTRACT, a POLICY OF INSURANCE by which the Company and LESSEE together and severally are protected against liability and/or loss arising out of the condition, maintenance, use or operation of the property herein Leased in amounts of not less than the minimums required by the State of ___________________. LESSEE shall be considered in default should he fail to provide, maintain or pay for the insurance as required herein. The Company may, at its option, purchase the insurance coverage at the expense of the LESSEE.Insurance Company to hold policy: ______________________________________ Agent: ___________________Insurance Company Phone: ___________________ Policy Number: ______________________________________Type of Insurance: ______________________________________ Expiration: ______________________________________4. MAXIMUM AMOUNT OF LIABILITY of the LESSEE at the end of the Lease term shall be the same as the above shown Original Value unless LESSEE keeps the vehicle until ___________________ and keeps his account current, at which time he may purchase the vehicle for the amount of one dollar ($1.00).5. The TERM of this Lease shall be a maximum of TWO WEEKS (14 DAYS) unless otherwise stated commencing on the date of execution of this Lease. Under no circumstances shall the obligations of the LESSEE cease before the property is surrendered and the settlement of account is accepted by the Company.6. SETUP FEE: There is a Setup Fee of $___________________ which includes licensing, registration, title, insurance verification, credit information, transportation, taxes, and other fees not necessarily fixed under this agreement.NOTICE TO LESSEE: A. DO NOT SIGN THIS AGREEMENT BEFORE YOU READ AND UNDERSTAND IT. B. YOU ARE ENTITLED TO A COMPLETED COPY OF ALL PAGES OF THIS AGREEMENT. C. YOUR SIGNATURE INDICATES YOU HAVE READ THE AGREEMENT AND HAVE RECEIVED A COMPLETED COPY.D. FAILURE TO RENEW THIS CONTRACT OR RETURN VEHICLE ON THE DUE DATE WILL RESULT IN THE VEHICLE BEING REPORTED AS STOLEN AND YOU MAY BE CONVICTED OF A FELONY AND BE FINED AND IMPRISONED. YOU ARE RESPONSIBLE FOR ALL COSTS INCURRED. =7. NO ABATEMENT OR SETOFF: LESSEE agrees that the sums payable to the Company shall not be subject to any abatement whatsoever, nor subject to any defense, set-off, counterclaim, or recoupment by reason of any damage to or loss or destruction of said property.8. ALL DEPOSITS, FEES AND FIXED RENTAL PAID UNDER THIS CONTRACT ARE NON-REFUNDABLE. 9. LICENSES, TAXES, FEES, EXPENSES: In addition to fixed rentals, sales tax, initial and subsequent license and registration fees, Lessee agrees to pay all costs, expenses, fees, and charges in connection with the use and operation of the property during the term of this Lease as well as any and all increased or added sales taxes, personal property and other ad valorem taxes and assessments and/or other governmental charges whatsoever on the said property, or on the use, ownership, possession, Lease, transportation, delivery, or operation of the same. Lessee agrees to reimburse the Company for the full costs, expenses, taxes, fees, and other charges paid by the Company which Lessee is obligated to pay. - 3 - 10. NO AGENT OR EMPLOYEE OF THE COMPANY SHALL HAVE THE POWER TO WAIVE ANY OF THE TERMS OR PROVISIONS HEREOF, or to incur additional obligations on behalf of the Company unless such waiver or additional obligations are evidenced by an agreement in writing signed by a duly authorized officer of the Company and by the Lessee.11. USE OF PROPERTY: Lessee agrees that during the term of this Lease he will use the property for lawful purposes only and the property shall not leave the state of ________ without the expressed written permission of the Company. Lessee agrees to indemnify and hold the Company harmless from any fines or penalties for violation of any laws or illegal use of the property.12. ASSIGNMENT/SUBLEASING: Lessee agrees that he will not assign, transfer, sublet, or in any way rent or lease his rights hereunder and will not lien or cause to be liened the property described herein.13. MAINTENANCE & REPAIRS: Lessee agrees to maintain the property in good working condition and not to misuse or abuse it.14. DAMAGE, DESTRUCTION OR THEFT: Lessee assumes the entire risk of loss or damage to the property from any cause whatsoever and the obligation of the Lessee shall not be affected in any manner irrespective of any damage, loss or destruction thereof. 15. INDEMNITY: the Company shall not or under any circumstances be liable for any damage or injuries to persons or property suffered or sustained in the use, condition, or operation of the property and all such claims are specifically waived by Lessee. Company makes no warranties, expressed or implied, as to the condition of the property or its fitness for any particular purpose. Lessee agrees to and does hereby hold the Company, its agents and employees, free and harmless from any and all losses, costs, demands or liability of any kind whatsoever, including legal costs and attorney's fees. Upon demand, Lessee shall defend at Lessee's own expense, any claims brought against the Company.16. TERMINATION OR DEFAULT: For any reason of termination of this contract, the Company shall have the right to take possession of the property and sell it to the highest bidder and the Company shall retain all proceeds. 17. ATTORNEY'S FEES/LEGAL COSTS: In the event Lessee shall default hereunder, the Company shall be entitled to recover from Lessee, in addition to all other damages, all costs and expenses, including court costs and reasonable attorney's fees by the Company to enforce its rights.18. CRIMINAL CHARGES: In the event Lessee defrauds the Company in any manner, Lessee hereby ADMITS to all criminal charges involved and authorizes any attorney at law or attorney- in-fact to appear in any court of record in the State of ________, or any other State in the United States, and waive the issuance and service of process, and CONFESS JUDGMENT AGAINST ME, in favor of the Company for all amounts due including costs of suit and reasonable attorneys' fees, and to release all errors and waive all rights of appeal.19. TITLE: The Title to the property shall at all times remain in the possession of the Company or its nominees, successors, or assigns. The Company may at any time, sell or assign this contract, including its interests in moneys due hereunder.20. SEVERABILITY, WAIVER, ENTIRE AGREEMENT: Any provisions of this contract which shall prove to be invalid, void or illegal will in no way affect, impair or invalidate any other provision hereof and such remaining provisions shall remain in full force and effect. The parties hereto have read this entire Lease and do hereby acknowledge that they are familiar with all of the terms, covenants and conditions set forth herein and that there are no other representations, warranties, or agreements concerning this contract which do not appear in writing herein. There shall be no alterations, change or modification of any of the terms, covenants and conditions of the Lease except in writing and signed by all parties hereto. LESSEE IS OF SOUND MIND AND HAS READ AND UNDERSTAND ALL THE ABOVE. Lessee understands this is a type of credit and authorizes review of Lessee’s credit history via consumer reporting agency, police agency, telephone or utility company to give all information about Lessee to this Company or its agent. Lessee further understands and agrees that a copy of this Agreement shall be as binding as the original and that it has no expiration date.IN WITNESS WHEREOF, on this date the parties hereto have executed this Lease Agreement:Lessee signature: ____________________________ Lessee name: _____________________ Date: _________Company: ___________________________ By: _______________________ Title: ______________________