*If you have scripting disabled, please do not use the enter key to scroll or it will immediately submit the form partially completed.

Which car would you like?

Please enter information here

Work:   Ext:

Exp. Date(mm/yy):

State issued: Pick a State Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Street: 

City:    

Policy Number:

Exp. Date(mm/yy):

Insurance Agent's Name: 

Agent's Phone: Ext.

Occupation:

Employers Address:

Street:

City:

Street:

City:

When did you speak to a representative?

Date(mm/dd/yyyy):

Release Form

Please read following and complete required fields.  This application will not be processed unless following section is completed.

     I agree that Mach 5 Cars, LLC, in order that they may confirm my identity and suitability for the rental of one of their vehicles, is authorized to conduct or perform any verifications they deem necessary including, but not limited to Motor Vehicle License check, address verification, automobile insurance verification, employment verification, criminal check and credit worthiness. I release Mach 5 Cars, LLC from any liability and authorize them in this regard.

I authorize Mach 5 Cars, LLC to obtain my
insurance information from .

Policy Number

Please provide policy limits and deductibles to Mach 5 Cars, LLC upon their request.

I also authorize Mach 5 Cars, LLC to charge my credit card for the amounts discussed in the accompanying email/fax or previous discussions for the reservation and deposit for overages.

Cancellation Policy & Fees: I recognize that this rental is for a unique and specialized vehicle and my reservation will be guaranteed and the rental vehicle will be held for me until the scheduled rental time. There is a $100.00 cancellation fee if the reservation is cancelled within 10 days of the rental period.

A 50% charge of the total rental price will apply if you cancel within 5 days of the rental period. A 100% charge of the total rental price will apply if you cancel with 72 hours of the rental period or if you do not show up for the rental. Call from 9:00AM – 5:00PM Monday through Saturday to cancel.

I also acknowledge that smoking is not permitted in any vehicle.

Please state whether you agree or disagree: I Agree I Disagree

Your Name:      

     Month: -select one- January February March April May June July August September October November December Day: -select one- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: 2011 2012 2013 2014

Please remember if renting a sports car, to  submit the Rainy Weather Form.

VERY IMPORTANT -  IF YOU LEAVE INFORMATION OUT, WE CAN NOT PROCESS YOUR APPLICATION, SO PLEASE COMPLETE AS MUCH AS POSSIBLE