Customer Name*

First Last

Cell Number*

Drivers License #*

State*

Expiration Date*

Date of Birth*

Partner/Renter 2 Name

Cell Number

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer/Company

Position

Work Phone Number

Insurance Agent's Name*

First Last

Insurance Company*

Policy Number*

IF COVERAGES DO NOT TRANSFER FROM YOUR AUTO POLICY, MBA INSURANCE OFFERS COVERAGES – WE WILL REQUEST COVERAGES THROUGH YOUR INSURANCE COMPANY FIRST, SO ALL INFORMATION ABOVE IS REQUIRED. CUSTOMERS PURCHASING COVERAGES THROUGH MBA INSURANCE YOU WILL HAVE AN ADDITIONAL COVERAGE DEPOSIT OF $1000 PAYABLE VIA CREDIT CARD OR CASH PRIOR TO DEPARTURE. THIS IS FULLY REFUNDABLE SO LONG AS THE RV IS RETURNED IN SAME CONDITION AS IT WENT OUT.

Phone Number

Agent's Fax Number*

Are you interested in additional insurance?*

Group # Requested*

Unit Number

Price Quoted*

Departure Date*

Weekdays only!

Time

SUMMER 1-4pm/WINTER 9-4pm

Return Date*

Sunday through Friday only!

Time

SUMMER 8-10am/WINTER 9-4pm

Destination*

City State

Estimated Round-Trip Mileage*

Free Mileage Included

Number of People Traveling (include children)*

Are you traveling with pets?*

Pets require an additional fee of $25. Leave no trace of pets upon return!

Add'l Mileage Charge

40c each or $375 per 1000

Check the options you need (fees apply):

Linens
Towels
Post-Cleaning
TT Generator
TV/DVD
Chairs
Bike/Cargo Rack
Tow w/RV
Delivery

Linen Quantity

Bike/Cargo*

Did your quote include an approved delivery/price?

Yes

Delivery Address & Price Quoted

Other

How did you hear about us?

Have you rented before?*

From here?

List any additional drivers EXCEPT those on your policy

First Last

Other Driver's Phone Number

Other Driver's Auto Policy Number

Insurance Agents Name and FAX #

Incomplete applications will not be processed. *A $500 reservation deposit (non-refundable if you cancel) must accompany application. The reservation deposit will apply toward your security deposits upon pick up. Cancellations less than a 30 day notice prior to pick up you will be responsible for the full rental price, credit will be given for re-rented amount of time. Sorry, no refunds on early returns and all units are non-smoking. If customer purchases coverages from MBA Insurance, an additional $1000 coverage deposit (refundable) will be due at the time of departure. Security and Coverage Deposits are fully refundable within 30 days so long as the rental is returned in the same condition as it went out.

Customer Signature*

Please enter your full name. This is considered your digital signature.

Email Address*

Ok to email?

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ONLINE RV RENTAL APPLICATION FORM

RENTAL APPLICATION

Rental Application

ONLINE RV RENTAL APPLICATION FORM

RENTAL APPLICATION

Rental Application

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