Blake’s Car Rental & Lease Application Form

Employer Imformation
Company Name
Company Phone Number

Area CodePhone Number
Company Phone 2

Area CodePhone Number
E-mail
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Insurance Name & Address

Name

Street Address

CityState / Province

Postal / Zip CodeCountry

Business References
Reference 1: Name
Phone Number

Area CodePhone Number
Phone Number 2

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Reference 2: Name
Phone Number

Area CodePhone Number
Phone Number 2

Area CodePhone Number
Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

My Products

2023 Bintelli LIF Golf Cart. Grey 2023 Bintelli LIF Golf Cart Serial Number 7R3BA4236PC000391

2023 Bintelli LIF Golf Cart$40.00

Grey 2023 Bintelli LIF Golf Cart Serial Number 7R3BA4236PC000391

Quantity
Item subtotal:

Total $0.00

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Agreement

(By checking these boxes you are agreeing to our terms & conditions of keeping & caring of our motor vehicle rented & are liable to repair any damages or replace unit if stolen while in your custody - should you have any questions please contact us)
Agreement and Terms
Agreement and Terms
Agreement and Terms
Default Driver Digital Signature

First NameLast Name
Digital Signature Date

MonthDayYear
2nd Driver Digital Signature

First NameLast Name
Digital Signature Date 2

MonthDayYear

Upload a copy of your driver's license
Signature
Should be Empty: