ONLINE RV RENTAL APPLICATION FORM RENTAL APPLICATION Rental Application Customer Name* First Last Cell Number*Drivers License #*Country/State/Province State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Expiration Date* Month Day Year Date of Birth* Month Day Year Partner/Renter 2 NameCell NumberAddress* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Employer/Company*PositionWork Phone NumberInsurance InfoContact your insurance company and let them know that you are renting an RV. Include the insurance company's fax number, contact person, and your policy number on the application. All insurance information is mandatory and must be complete. We will provide you with the information needed for the insurance binder. Additional insurance is available for purchase from MBA insurance. Please call for quotes and information. If you purchase coverage through MBA insurance, an additional insurance deposit of $1000 (refundable) will be due at pickup. This may be paid by check, cash or credit card. If you pay with a credit card a 3% fee will apply.Insurance Agent's Name* First Last Insurance Company*Agent's Phone NumberAgent's Fax Number*Policy Number*Are you interested in additional insurance?*Select optionYesNoGroup # Requested*Select a groupTravel Trailers - Group #1Travel Trailers - Group #2Travel Trailers - Group #3Travel Trailers - Group #4Travel Trailers - Group #5Motorhomes - Group #6Motorhomes - Group #7Motorhomes - Group #8Unit NumberPrice Quoted*Departure Date* MM slash DD slash YYYY Weekdays only!Departure Day of the WeekSelect Day of the weekMondayTuesdayWednesdayThursdayFridayTime SUMMER 1-4pm/WINTER 9-4pmReturn Date* MM slash DD slash YYYY Sunday through Friday only!Return Day of the WeekSelect Day of the weekSundayMondayTuesdayWednesdayThursdayFridayTime SUMMER 8-10am/WINTER 9-4pmDestination (Furthest Location Traveling)* City State Please enter the furthest destination of the city and state that you are going to.Estimated Round-Trip Mileage*Free Mileage IncludedNumber of People Traveling (include children)*Are you traveling with pets?*select optionYesNoPets require an additional fee of $25. Leave no trace of pets upon return!Add'l Mileage Charge40c each or $375 per 1000Check the options you need (fees apply): Linens Towels Post-Cleaning TT Generator TV/DVD Chairs Bike/Cargo Rack Tow w/RV Delivery Linen Quantity1 Set2 Sets3 Sets4 Sets5 Sets6 Sets7 Sets8 Sets9 Sets10 SetsBike/Cargo*Please Select a Rack TypeBikeCargoDid your quote include an approved delivery/price? Yes Delivery AddressPrice QuotedOtherHow did you hear about us?Have you rented before?*Select optionYesNoFrom here? Yes No List any additional drivers EXCEPT those on your policy, must me present at pickup. First Last Other Driver's Phone NumberOther Driver's Auto Policy NumberInsurance Agents NameInsurance Agents FAX #Rental fees, mileage, refundable security/insurance deposits and charges for additional services are due upon departure. The refundable security deposit is $500 and is payable by check cash or with credit card. If you pay the deposit with a credit card a 3% credit card fee will be charged. This deposit will be billed apart from the rental fees. Security deposits are refunded within 2 to 7 business days of your return, any additional charges will be taken from this deposit. If you have any damages this will delay your refund. Cancellations with less than 30-day notice you will lose your $500 deposit. If you cancel more than 30 days in advance you will be refunded the $500 deposit less a $100 processing fee. Sorry, no refunds on early returns.Customer Signature*Please enter your full name. This is considered your digital signature.Email Address* Ok to email?Select OptionYesNoCAPTCHA Δ Share this: Share on Facebook (Opens in new window) Facebook Share on X (Opens in new window) X
