Hertz Rental Car Request Form - Member Submission

Renter's Name*

First NameLast Name

MemberGuest

Member Account Number*

Guest Account Number

*If applicable

Renter's Cell #*

Driver's license of renter:

Browse Files

If not already on file*

Hertz Gold #

*If applicable

Arrival Date & Time

DateHourMinutesAM/PM Option

Departure Date & Time

DateHourMinutesAM/PM Option

Vehicle Type*

Preferred Vehicle Choice

Ex: Toyota Rav-4, Chevy Tahoe, GMC Yukon XL

Snow Tires Requested?*

Total Days Rented*

Include day of arrival and return

Rental Insurance*

LDWLISPAIFull Coverage

Cost of Protection Options (Per day pricing)

Coverage Details

LDW - Loss Damage Waiver is an optional product that waives your financial responsibility for any loss or damage incurred to your Hertz car rental. With the exception of using the vehicle in violation of the rental terms or for a prohibited use as specified in the rental agreement. This can save your time and money if an accident happens during the rental.

LIS - Liability Insurance Supplement provides protection from third-party automobile liability claims for the difference between the liability protection limits and a maximum combined single limit of $1,000,000. LIS safeguards your insurance policy and/or your personal assets for the first $300,000 (in each case inclusive of any applicable minimum underlying state statutory limits) should such claims be made against you. LIS provides uninsured/underinsured motorist coverage up to $100,000 per occurrence (in each case inclusive of any applicable minimum underlying state statutory limits) for combined third party bodily injury and/or third party property damage claims.

PAI/PEC (elected together) - Personal Accident Insurance (PAI) allows you to elect accidental death and accidental medical expense coverage for yourself and your passengers during the rental period of the vehicle.
Personal Effects Coverage (PEC) is an option that insures against risk of loss or damage to certain personal belongings while renting from Hertz.
By electing PED, you will be insured throughout the entire rental period.

Vehicle Pick Up Location*

Where will the car be sitting when renter arrives?

Vehicle Drop Off Location*

Where will the car be sitting when the renter departs?

Arrival Flight Info

Only needed if terminal/YJC/Arlins pickup

Departure Flight Info

Only needed if terminal/YJC/Arlins pickup

Notes/Special Requests

Car seats (forward or rear facing), booster seats, snow tires, questions, etc.

Name of person completing form:*

First NameLast Name

Email for confirmation details:*

example@example.com

Once this form is submitted, we will reach out to our third party rental car vendor to book based on their availability.

We will contact the email above shortly.

Hertz Rental Car Request Form - Member Submission

Trip Information