Vehicle Rental Request Form

Vehicle Rental Request Form

Requesting Party Name:    Contact Phone:

Rental Company Name:    Company Contact:

Recitals

WHEREAS, Requesting Party has requested temporary use of one or more motor vehicles for the purposes described in this form and subject to the terms and conditions set forth herein; and

WHEREAS, Rental Company is duly authorized to provide motor vehicle rentals and is willing to provide such vehicle(s) to Requesting Party upon acceptance of this request and execution of the rental agreement;

WHEREAS, the parties intend this Vehicle Rental Request Form to set forth the requested rental specifications and to be incorporated into the final rental agreement if accepted by Rental Company.

Scope of Work

Vehicle Details Requested

Rental Period & Locations

Requested Start Date:    Requested End Date:

Driver & Insurance Information

Driver Age:    Additional Authorized Drivers:

Yes     Covered under Rental Company policy     No / Will obtain separate coverage

Payment Terms

Late Fee (if payment not timely):    Currency:

Term and Termination

Agreed Start Date:    Agreed End Date:

Termination for Cause: Either party may terminate immediately for material breach that is not cured within the stated notice period. Upon termination, Requesting Party remains responsible for charges incurred through return of the vehicle and for costs of repairs for damage caused by Requesting Party negligence.

Confidentiality

Each party agrees to treat as confidential any non-public business or technical information disclosed in connection with this request and subsequent rental arrangement. Confidential information does not include information that is publicly available or independently developed. Recipient shall not disclose Confidential Information to third parties except to its employees or agents with a need to know and shall use at least the same degree of care to protect Confidential Information as it uses to protect its own confidential information, but no less than reasonable care.

Liability, Indemnification & Additional Terms

Requesting Party shall be responsible for all loss, damage, fines, tolls, parking violations, and costs attributable to the operation of the vehicle during the rental period. Requesting Party will indemnify, defend and hold Rental Company harmless from and against any claims, damages or liabilities arising out of Requesting Party's use of the vehicle, except to the extent caused by Rental Company's gross negligence or willful misconduct.

Fuel Policy: Requesting Party will return the vehicle with the same fuel level as at pickup. If returned with less fuel, fuel replacement and service charges will apply as assessed by Rental Company.

Damage and Wear: Normal wear is expected. Damage beyond normal wear will be assessed and charged to Requesting Party based on reasonable repair costs plus administrative fees.

Governing Law

This Rental Request and any subsequent rental agreement shall be governed by and construed in accordance with the laws of the state of without regard to its conflicts of law rules.

Entire Agreement

This Vehicle Rental Request Form, together with any accepted reservation confirmation and the final rental agreement signed by the parties, constitutes the entire agreement between the parties with respect to the requested rental and supersedes all prior proposals, communications and understandings, whether written or oral.

Authorization

By submitting this request, Requesting Party certifies that the information provided is true and complete, that the primary driver is legally authorized to operate the requested vehicle, and authorizes Rental Company to obtain any verification of license, insurance, or driving record reasonably necessary to process this request.

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