Identification Card Application - Hertz

Hertz Cash Deposit Identification Card

Application

TO APPLY FOR YOUR CARD: ? Complete both parts of this application

? Be sure to sign at the bottom

? Return with $15.00 non-refundable processing fee* to: Hertz Post Office Box 25991 Oklahoma City, OK 73125 (*Send Check or Money Order)

PART ONE Please Print Clearly

Last Name

First Name

Residence Address (Limit to 25 Letters Including Spaces)

City and State (Limit to 25 Letters Including Spaces)

Driver's License Number

Middle Initial Zip Code

Optional:

Employer or Firm Name (Limit to 25 Letters Including Spaces)

Mrs. Ms. Miss Mr. Dr.

Mail Card & Bill To: (Please Check One)

Residence Business Address Address

Business Address (Limit to 25 Letters Including Spaces) City and State (Limit to 25 Letters Including Spaces)

Zip Code

State

Expiration Date

Company CDP Number (if any)

Car Preference I Usually Rent

Luxury Premium

Full Size 4-Door Special Sporty

Mid-Size Compact 4-Door

Compact 2-Door This Card is For

If you have a major credit card, please indicate which one at right (e.g. Visa, Mastercard, Carte Blanche, Diners Club, American Express, Discover/Novus, JCB).

Name of Credit Card

Personal Use

Business Use

Both

Credit Card Account Number

PART TWO

Your Position

Type of Business

Business Tel. Number

Years With This Company

Annual Income

Residence Telephone Number Previous Employer

Years at This Address Own Home Rent

Date of Birth

Years With This Company

Personal Checking Account (Bank Name) Branch Address

Social Security Number

Account Number

Spec. Reg.

Previous Employer's Address, No., Street, City & State

Previous Residence Address (If Present is Less Than 5 Years)

Name/Address of Closest Relative Not Living With You

Other Major Credit Cards: Company & Number

1.

Number

2.

Number

Please issue a Cash Deposit Identification Card ("Card") to me in the name set forth above. I understand that a Card will not be issued to me unless I am at least 21 years of age. Exceptions to this age restriction apply for use on rentals in the states of Michigan and New York, wherein an application for the Card may be made if I am at least 18 years of age. The Hertz Corporation ("Hertz") is authorized to verify any information it requires for this application including but not limited to the use of information obtained through various credit reporting agencies, subject to the Fair Credit Reporting Act. I understand I will be required to leave a deposit in cash, in accordance with Hertz' then current rules, at the time and place of each rental as a condition precedent to such rental and will pay all charges incurred for such rental in excess of such deposit, in cash, immediately upon completion of such rental. A CARD IS NOT A CREDIT CARD, NOR WILL IT ENTITLE ME AS A CARDHOLDER TO CREDIT PRIVILEGES.

The Card will be issued only on approval of this application by Hertz, and Hertz, in its sole discretion, retains the right to accept or reject this application. If the application is rejected, the $15.00 processing fee WILL NOT BE REFUNDED. If a Card is issued to me, it will be accompanied by a cardholder agreement.

My retention and/or use of the Card will constitute my agreement to be bound by all of the terms and conditions set forth herein.

The Card is the property of Hertz System, Inc., and is non-transferable. The Card may be cancelled, invalidated, and/or the conditions of its use modified without notice to me. I will surrender it to Hertz upon request. Hertz reserves the right to repossess a Card with or without demand, and I hereby waive prior notice, a pre-seizure hearing and judicial process as a prior condition to Hertz's repossession of the Card.

Cash Deposit Identification Card may be used at Hertz, Dollar Rent A Car, Thrifty Car Rental and Firefly Rent A Car.

I understand that only I will be authorized to use the Card. I will be liable for all charges incurred by authorized use of the Card. I will also be liable for unauthorized use occurring prior to notifying Hertz at P.O. Box 25991, Oklahoma City, OK 73125 or by telephone at 800-654-4173 of loss, theft or possible unauthorized use. Written notice will not be effective until received by Hertz.

Applicant's Signature

Date

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download