Blake’s Car Rental & Lease Application Form

Employer Imformation
Company Name*
Company Phone Number*
Area CodePhone Number
Company Phone 2
Area CodePhone Number
E-mail*
Company Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Bank Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry

Business References
Reference 1: Name
Phone Number
Area CodePhone Number
Phone Number 2
Area CodePhone Number
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
E-mail
Reference 2: Name
Phone Number
Area CodePhone Number
Phone Number 2
Area CodePhone Number
Address 2
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry

Agreement
(By checking these boxes you are agreeing to our terms & conditions of keeping & caring of our motor vehicle rented & are liable to repair any damages or replace unit if stolen while in your custody - should you have any questions please contact us)
All invoices are to be paid in full days from the date of the invoice & delivery or pick up of the motor vehicle.
I am agreeing to your terms & conditions of keeping & caring of this motor vehicle rented or leased & I am commuting to repair any damages or replace unit if stolen while in my custody.
By submitting this car rental & lease application, you authorize us to make inquires into the place of employment stated above and the buisness references that you provided.
Default Driver Digital Signature*
First NameLast Name
Digital Signature Date*
MonthDayYear
2nd Driver Digital Signature*
First NameLast Name
Digital Signature Date 2*
MonthDayYear

Blake’s Car Rental & Lease