RENTER INFORMATION:
First
Driver Information:
Name:___________________________Date:_______________Telephone:______________________
Social Security No.__________________Driver’s License
No.____________________State:______
Email:___________________________________________
Present
Address:_____________________________________________________________________
City:______________________________________________State:_______________Zip:__________
How long have you lived at the above address?_______ If less than 6 months fill
out previous address below.
Employer:___________________________________Position:_________________________________
How long?___________Telephone no._______________________
Second
Driver Information:
Name:___________________________Date:_______________Telephone:______________________
Driver’s License
No.____________________State:_________
Present
Address:_____________________________________________________________________
City:______________________________________________State:_______________Zip:__________
Employer:___________________________________Position:_________________________________
How long?___________Telephone no._____________________________
Towing Vehicle Information:
Make/Model_______________________________Year_________Color____________
License Plate ________________State_____________VIN No.____________________
Does the Towing vehicle have a trailer brake control switch
installed?_______________
A trailer brake control switch communicates with the electric brakes on the
trailer. It is a box under the dash of the towing vehicle that is usually
not included in a standard tow package. This control box is required by
State Law to
tow any of Wheeler Rentals trailers.
Is the towing Vehicle equipped with a 7 round plug?___________ a Trailer brake
Control Switch?____________
and a 2 5/16" ball or 2" for
17' trailer? ____________
Is there going to be another vehicle towing this trailer?___________
If yes, fill out information for second vehicle.
Insurance
Information:
Insurance Company:____________________________________
Policy holder:_______________________________Policy #__________________________
Effective Date________Exp. Date:_________
Agent Name:_______________________________Agent Telephone
No._________________________
Claims Telephone No.______________________________