Apply for Rental

Exotic Car Rentals of New Jersey, LLC
 

*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 your e-mail address:  
     
Pick-up date:
    
Month: Day: Year:
 
Time:    
Drop-off date :    
Month: Day: Year:    
Time:

 

  
Purpose/Destination: (if you're completing this for someone else and this is a surprise, please enter your name and your contact information below as well as the Purpose/Destination) - if you are an ITEX member and this is an ITEX rental, please include your ITEX number

    
Renter Information (the renter is the driver so enter driver's info below):
Renter's Name:
    
   
Date of birth  (mm/dd/yy):
    

Address:

    

Street:

   

City:

   

State: Zip:

   
Phone Numbers:
Home:
   
Cell:    
Work: Ext:    
     
     
Drivers License Info
   
Number:
   

Exp. Date(mm/yy):

   

State issued:

   

Social Security Number

   
     
Credit Card Information - IMPORTANT, IF USING A DEBIT CARD, PLEASE CALL US TO ADVISE    

Credit Card Number Call if this is Debit Card

    

Exp. Date(mm/yy):    

   
Security Code:          AmEx - above and to right of credit card number, others on back on signature line (last three digits)

Credit Card Billing Information - please leave blank if same as residential address above

Street:

City:    

   

State:   Zip:

   
Insurance Company    

Street:

   

City:

   
St: Zip:    

Policy Number:

   

Exp. Date(mm/yy):

   

Insurance Agent's Name: 

   

Agent's Phone: Ext.

   
     
Employer's Name:
   

Occupation:

   

Employers Address:

   

Street:

   

City:

   
St: Zip:    
     
Emergency Contact
(Preferably someone who doesn't live with you)
    
Name:    
Relationship:    

Street:

   

City:

   
St: Zip:    
Telephone:   
How did you hear about us?
    
If other:    

   
Name of the Exotic Car Rentals rep    
   

When did you speak to a representative?

    

Date(mm/dd/yyyy):

   
Rate Quoted: $

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

We will not process your application if the Release Form has not been submitted!

  


 

Call and make an appointment today (866) 730-CARS. Open all year.

We happily accept:

Cloud Nine Car Rental
Exotic Car Rentals of NJ is a Cloud 9 affiliate
Toll Free: (866) 730-CARS (2277)
Fax: (866) 322-0210
Email: Info@ExoticCarRentalsNJ.com