Loaner Vehicle Assignment of Liability Agreement
Driver Information
Name:
*
Address:
*
City:
*
State:
*
Zip:
*
Email:
*
Phone:
*
Alternate:
DL#:
*
State:
*
Exp:
*
Insurance Company:
*
Policy Number:
*
Expiration:
Please read and initial:
Initial
Initial

Renter Acknowledgment

I acknowledge that I have read, understood, and voluntarily agree to all terms of this Agreement.

Loaner Vehicle Assignment of Liability Agreement
Credit Card on File — last 4:
Brand:
By signing below, I authorize Pinnacle Auto Rental to charge the credit card on file for any amounts owed under this Agreement, including but not limited to damage, fuel, cleaning, tolls, fines, storage, and the refundable deposit. This authorization remains in effect until the rental is closed and all charges are finalized.
Printed Name:
Signature:
Sign here
Date:
Date
Agent:
Vehicle Information
Year:
*
Make:
*
Model:
*
Color:
*
Plate #:
*
State:
OUT Date:
*
Mileage:
*
Fuel:
*
Beginning Condition: please note all scratches, dents, stains, etc.
Customer Signature:
Sign here