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LESSOR:HERTZ SYSTEM MEMBER .- ` _ r- ~ ~' PRIC~'S TFtUC3:~+'"''AR ~d~HTAL SERViGE ,,,~r ' L' 195 C0149tJ~!~eCfAL STREET S.E. ^ Insurance , Cert'rficate On ' ~ SALEM, OR 97~1 Fite HERTZ SYSTEIUb, INC. (~~ ~I^~{~ TO BE PAID BY: (CHARGE CARD IMPRINT HERE) ~ ~ ~ t `~-~i !~ /~~~~1 ri'd ~1 U~ ~ ~r CARD AMOUNT CREO ~R PURCHASE O DER NO. DATE NO. COMPANY NAME (PLEASE PRIN~ ~ ~ S7REET , f I ' ' r.. ISOiSEiNO.i_I I I-I I ~ PHONE N`O. ~ / CUSTOMER ACCOUNT NO. D R I DRIVER'S LIC NSE O. V E R ADD'L DR R'S LICE SE NO. ADD'L ORIVER'S NAME CLASS CLASS VEHICLE NO. LIC E NO. ~. STATE M ~ BODY SIZE VEHICLE HEIGHT I I I I ~C U MAX.PAYL HANDTRUCK NO. OTHER ^ ~ CONTRACT SUPPORT ^ INTERIM ^ ADDITIONAL GUARANTEED DTR FEQUIRED MILEAGE SCHEDULE ^ SU&STITUTE FOR VEHICLE NO. ^ YES ^ NO ^ YES ^ NO OUT E Ys '/< 3i5 ~/x 5I9 ~~9 '/e ouarnTr IN E YB '/~ 31U '/z 5/e 3/a ~/e F HANDTRUCK DATI LIMITED LOSS AND DAMAGE WAIVER (LDW) PADS Customer shall return Vehicle to Lessor in the same condHion as received, ordinary wear excepted.if Vehicle is used with Lessor's permission and on the terms set forth in paragraphs 5, 6, 7, 9, 70, & 11 on reverse side,and sustains damage, OTHER EQUIPMENT Customer's responsibility for the loss or damage, including loss of use, is Limited to if Customer accepts LDW at the time of rental by initialingthe accept box below and pays the add'Aional fee specified in the computation column or Customer shall pay the full cost of loss or damage, including loss of use to Vehicle if declines box below is initialed. MUST be inkialed) i f h t ll ng o ow t e PHYSICAL DAMAGE TO VEHICLE (NO7E: Only one o ~ ~ Customer deciines LDW and agrees ~,. ~. Gr1A~tt3t Customer accepts LDW. to paythe full cost of loss or damage ~ to the Vehi 'ne1E~2J'1 s of use. Cp~ IYtILE LD IS T URANCE ~ ADJi1ST. SU&TOTRL - X INITIAL CUSTOMER IS RESPONSIBLE FOR ALL OVE AMAGE `~ T'~ ACCEPTS~ PERSONACACCIDENTI U NCE~PAp s D CLINE (.~; " 17~q~ St4mer declines or accepts PN. If acc o epts coverage at the rate shown above antl acknowledges to have reatl Me SVNOPSIS W ii fu shed by Lessa at rental. INITIAL ~~~ ~EJ~{~iE n it ialed.) ~ i LIABILITV PROTEfiTION N yw f e folbwing mu t ~~~ /// iii ~~~ LiabilityProtectioninparagraph]DfT~~~~~~h'Insura ~~yCuslomer P~ on reverse side provided by Le~or ~ as para rse side. ITIAL DISPATCHED Cusr. LeSSOR ^ WITH DAMAGE ~ O WITHOUT DAMAGE WITIALS INITIALS~ . CUSTOMER SHOULD READ THE ADDITIONAL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS AGREEMEI WARNING: Minimum Charge: One Day Plus Mileage Charges ' Vehicle shall not be operated by any person except Customer and the following Authorized Operators who must be 21 or more years of age, duly qi licensed to operate Vehicle, and have Customer's prior permission. Authorized Operators are; the employer, partner, executive officer, or regular employee additional authorized operator(s) approved by Lessor in writing. Customer will not surrender the use of Vehicle to anyone other than the pre operetor(s). ' Credft Card Customer auihorizes Lessor to process a credit card voucher ('rf applicable) in Customer's name for all charges. If Customer elects to retur fuel than when rented, Customer shall pay Lessor's refueling service charge. DeposH will not be refunded in full until all amounts due under this Agreement damage are paid and all equipment rented by Lessor returned at the time Vehicle is checked in. All charges are subject to final audit by lessa. ` LESSOR MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, INCLUDING, BUT NOT LIMITED TO THE IMPLIED W MERCHANTABIUTY AND FITNESS FOR A PARTICULAR PURPOSE. CUSTOMER REPRESENTS THAT HE/SHE HAS FULLY INSPECTE DESCRtBED HEREIN AND THAT SAME IS IN GOOD CONDITION AND REPAIR. ` Customer is liable for all damages to Vehicle as a result of insuHicient clearance (height or width) and fa all parking and traffic violations, and must imr accidents and complete Lessor's accident report form. ~ - ` The Vehicle described herein is rented pursuant to and in accordance with the terms and conditions set out above and on reverse side of this Agr~ represents that he/she has read and agrees to same, and has received Vehicle Inspection Report and Driver Trip Reports where and when required complete and return them to Le reverse side. CUSTOMER'S ~/ '~~~~ ~i~~f / REFUND RECEIVED/APPLIED TO R/A SIGNATURE /\ .~ 7 ( S/' /~ X RENTAL AGREEMENT NO. ~ RENTAL AGREEMENT NUMBER LT - 751254 ~` PLEASE BE SURE TO SHOW THIS NUMBER ON ALL CORRESPONDENCE MILEAGE DETERMINED BY READING FACTORV ODOMETER OP THE LOCALLY INSTALLED HUBODOMETER DO NOT SHOW TENTHS • • • • • •' • ~ i ~ MILEAGE IN ~ ~ ~ i ~ i i MILEAGE OUT i ~ i i i i ~ MILES DRIVEN i ' { i i ' i i i MILES ALLOWED i ' i i i i ~ i i i MILES CHARGED i ; i i ii i REFRIG. HRS. END i i i i i i i i i i REFRIG. HRS. BEGIN i i i i i i ~ i i i TIME A.M. .: I MO Y IN r- r D TIME N 1' ~ IN P.M. TIM TIME H VEA Q t / ~+' • • LOCAL CHARGES ; ' PER A DAY O i ' EXTRA ~ PEFi ~ HRS. '~,,.~ HR j 7 PER EEKS yyK. ~ i . ADD'L M~~ ~~ i ~ MILES SUB TOTAL ~ i SUB TOTAL ~ ; ~ i DAYS C°~ PER ~ ~ DAY i PER DAYS Q° DAY ~i i DAYS ~a Y i i DA i i i R~"~~.~Aa '~ •o •• •~~~o• <PFFiMfLE m m~~ o e ~j`~{ q~(uST ' ' •• . •~~~on ~ Si1B-TOTAL - ~ ; % TAX ; ~ P~fl ~ OAY i •o •ssoos G~. ,- .-. R Fi1ELS`~~`.'i:a ~ oe .~.eo•• ADDL (~ REZ DAYS DAY i i SUB TOTAL ~ 'i i LESS OIL i AND REPAIRS i i 7 REBILL i alified and validly SUB TOTAL , i ~ s) of Customer, or iously described LESS IT REC'D ~ DA i i Vehicle with less TAL ~ i ncludingphysical T ~ i \RRANTIES OF • ~ • - ) THE VEHICLE CASH i iediately report all ~ CHARGE CARD ement Customer ~ . flnd will pfortlptly ^ PURCHASE ORDER ~ ^ DIRECT BILL REFUND ~ ^ CASH O CHECK i ORDERE~BV COMPLEfED BV REPORTDATE AR V ETTV CASH CHECK NO. ~NITIALS 1 / / / 1 / r' /