RESERVATION APPLICATION

By submitting this application you are agreeing to the conditions outlined on the Rent a Folding Camper Page.
All submitted information will remain confidential.

TODAY'S DATE________________

PERSONAL INFORMATION
NAME(Last, First, MI)___________________________________________________________
ADDRESS____________________________________________________________________
CITY_________________________________STATE__________ ZIP_________________
COUNTY_____________________________PHONE ()__________________________
DRIVER'S LIC. NO.________________________________EXP. DATE_________________
SS#___________________________STATE_________DATE OF BRITH______________
EMPLOYER________________________________________PHONE ()____________
CREDIT CARD NO.___________________________EXPIRATION DATE_______________

AUTO INSURANCE INFORMATION
AUTO INSURANCE COMPANY___________________________________________________
POLICY NO.________________________________EXPIRATION DATE________________

EMERGENCY CONTACT
CONTACT NAME_______________________________________________________
PHONE NO. ()_________________

DEPARTURE DATE ________________
RETURN DATE____________________

PAYMENT

reserves the right to refuse any applicant and to change the subject matter of this agreement without prior
notification.

I have read and understand all charges and conditions of this agreement.

SIGNATURE_____________________________________________ DATE_______________