Nissan Rental Agreement

Rental Agreement

Company Name goes here

Customer Information

Customer:

Home Address:

City/State/Zip:

Phone:

Driver’s License No.: State: Expires:

Birth Date: Home Telephone:

Customer Vehicle Information

VIN:

Year/Make/Model/Color:

Additional Driver’s Name: Birth Date:

Driver’s License No.: State: Expires:

Additional Driver’s Name: Birth Date:

Rental Vehicle Information

Date In: Time In:

Date Out: Time Out:

Date Due: Time Due:

Customer Insurance Information

Insurer: Agent:

Policy No.: Expiration Date: Telephone:

Damage Description

Vehicle VIN: Fuel:

Vehicle Description:

Mileage In: Mileage Out:

Miles Driven: Miles Allowed:

Chargeable Miles:

Rates and Charges

Miles: @ $

Days: @ $

Taxable Fuel: @ $

Non-Taxable Fuel: @ $

Sales Tax %:

Total Charge:

Method of Payment

Amount: $

AMEX MC CHECK VISA OTHER

Expires: Card Verified:

Refunded: $

Fuel Disclosure

You are required to return the Vehicle with a full fuel tank. If the tank is returned less than full, you will pay us a refueling fee of $ plus fuel @ $ per gallon.

You agree to all the terms and conditions on both sides of this Agreement, and you acknowledge that you were given an opportunity to read this Agreement before being asked to sign. You authorize us to process a credit/debit card voucher in your name for all charges due under this Agreement. Your signature below is considered made on the applicable credit/debit card voucher. All charges subject to final audit.

The valid and collectible liability insurance and personal injury protection insurance of any authorized rental or leasing driver is primary for the limits of liability and personal injury protection coverage required by Florida Statutes.

Failure to return rented property or equipment upon expiration of the rental period and failure to pay all amounts due are prima facie evidence of intent to defraud, punishable in accordance with Florida Statutes.

Rental Agreement Terms and Conditions

1. Definitions. “Agreement” means all terms and conditions found on both sides of this form. “You” or “Your” means the person identified as the Customer on the reverse side of this Agreement, each person signing this Agreement, every Authorized Driver and each person or organization to whom charges are billed by Us at its or the Customer’s direction. You are jointly and severally bound by this Agreement.

2. Rental; Consideration; Indemnity and Warranties. This is a contract for rental of the Vehicle. A fee You pay Us, or Our opportunity to service or repair Your vehicle and the benefits We receive for the service/repair work, is adequate consideration for rental of the Vehicle.

3. Inspection; Condition and Return of Vehicle. You must return the Vehicle to Our office or other location We identify on the date and time specified in this Agreement with at least as much fuel as when rented.

4. Responsibility for Damage or Loss; Reporting to Police. You are responsible for theft of the Vehicle and damage to it whether or not You are at fault.

5. Prohibited Uses. The following uses of the Vehicle are prohibited and constitute breaches of this Agreement.

6. Insurance. You are responsible for all damage or loss You cause to others. You agree to provide auto liability, collision and comprehensive insurance covering You, Us and the Vehicle.

7. Charges. You will pay Us all charges due under this Agreement, including time and mileage, applicable taxes, and fuel charges.

8. Your Property. You release Us, Our agents, and Our employees from all claims for loss of or damage to personal property left with Us or carried in the Vehicle.

9. Breach of Agreement. You waive all recourse against Us for criminal prosecutions We take against You for breach of this Agreement.

10. Modifications. No term of this Agreement can be waived or modified except by a writing that We have signed or on a form that We provide.

11. Waiver. A waiver by Us of a breach of this Agreement is not a waiver of an additional breach or waiver of the performance of Your obligations under this Agreement.