Badgerland RV Rentals - Reservations Page

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RV Rental Reservation Form Badgerland RV Rentals INC., 1126 S. 72nd St. West Allis, WI 53214 Please fill out the form, Print and return it with a $500 deposit for Class C rental $1000 deposit for Class A Rental * Copy of driving record for all drivers Date: Unit:
APPLICANT INFORMATION LAST NAME:________________________________ FIRST NAME: _______________________________ MIDDLE INITIAL:____________ ADDRESS:__________________________________ CITY:_______________________________________ STATE/ZIP:__________________________________ DRIVER'S LICENSE# with STATE______________________________________ HOME PHONE:_______________________________ WORK PHONE:______________________________ E-MAIL ADDRESS__________________________	CREDIT HISTORY BANKING INSTITUTION:_________________________ CITY/STATE:_________________________ ACCOUNT#:__________________________ VERIFIED:___________DATE:____________ CREDIT CARD:___________________________ CARD#:_______________________EXP:______ DO YOU: OWN_____RENT______YOUR HOME?
	DRIVER HISTORY TRAFFICACCIDENTS:__________________ VIOLATIONS:__________________________ * Drivers Must Submit a Copy of their Driving Record with this rental form for each driver who will drive our RV's *Renters may obtain this form through your insurance company or the Wisconsin Department of Transportation.
EMPLOYER:_______________________________ ADDRESS:________________________________ CITY:_____________________________________ STATE:/ZIP:________________________________ WORK PHONE:_____________________________ POSITION:_________________________________ LENGTH OF EMPLOYMENT:__________________ VERIFIED:______________DATE:______________
AUTO INS. CO.:_____________________________ AGENT:___________________________________ CITY/STATE/ZIP:____________________________ VERIFIED:______________DATE:______________	RENTAL INFORMATION RENTAL DATES: FROM________TO_______ PICKUP DATE: DATE______________ RETURN: DATE______________ DESTINATION: ______________________ ESTIMATED MILEAGE: ______________________ MAXIMUM# OF PEOPLE:_____________________
EMERGENCY CONTACT NAME:_________________________________ TELEPHONE:___________________________
PLEASE LIST THE NAMES OF ALL DRIVERS BELOW (*All drivers must be 25 years of age)
1. LAST NAME:_________________FIRST:_______MIDDLE:__ADDRESS:_____________________________________ CITY/STATE/ZIP:___________________________________________D.O.B.:___________________ DRIVER'S LICENSE# with STATE_________________________EXPIRATION DATE:_____________STATE:_______ 2. LAST NAME:_________________FIRST:_______MIDDLE:___ADDRESS:_____________________________________ CITY/STATE/ZIP:___________________________________________D.O.B.:___________________ DRIVER'S LICENSE# with STATE__________________________EXPIRATION DATE:___________STATE:_______
WHERE DID YOU HEAR ABOUT US?:________________________________________ QUESTIONS OR SPECIAL ARRANGEMENTS?__________________________________________ ________________________________________________________________________________
I HAVE REVIEWED ALL OF THE INFORMATION PROVIDED ABOVE AND FIND IT TO BE CURRENT, CORRECT AND AGREEABLE TO ME. ______________________ _____________________________ CUSTOMERS SIGNATURE REPRESENTATIVE'S SIGNATURE