Ingham Te Awamutu Loan Car Form

Loan Car Form | Ingham Te Awamutu

Name *

First

Last

Email *

Mobile *

Loan Vehicle Details *

First

Last

Date / Time Loan Vehicle Commenced

Date

Time

Odometer reading on commencement

Date / Time Loan Vehicle to be Returned

Date

Time

Odometer reading on return

DAMAGE NOTED

COMMENTS

2. I confirm that I have a valid Driver’s Licence and am not currently disqualified or suspended from driving.

3. I acknowledge that I may be liable for charges if this loan vehicle is returned late or in different condition than at the time of loaning (in respect of damage incl. wheels and tyres, cleanliness or fuel level).

4. I agree to NO SMOKING or NO ANIMALS inside the vehicle.

5. I acknowledge no other person than those listed in this agreement are permitted to drive the vehicle.

6. The maximum distance travelled cannot exceed 250km.

7. I agree to pay for any costs incurred whilst the vehicle is in my care, including fines and in the event of an accident for which normal insurance cover is declined. I acknowledge the insurance excess payable is $2,500.

8. I am aware and acknowledge that this vehicle may have speed and location monitored by GPS.

Signature *

I (the driver) confirm that I take full responsibility for any penalties for traffic violations that are forthcoming that relate to incidents whilst the vehicle was in my possession.

Date of Agreement

Drivers Drivers Licence

Click or drag files to this area to upload. You can upload up to 2 files.

Please upload a copy of your drivers licence, front and back.