RICHR0UTE FLEET DRIVER APPLICATION

APPLICANT INFORMATION

This application is operated by RichRoute Fleet. A valid government-issued driver’s license and supporting information may be requested to verify identity, driving eligibility, income qualifications, and suitability for a RichRoute Fleet vehicle.

RichRoute Fleet will never ask you to submit identification merely to keep an online account active. For verification, contact us directly at (702) 775-6451 or visit https://richroutefleet.co.site/

Full Name

First NameLast Name

Date of Birth:

Date

Email Address

example@example.com

Phone Number

Area CodePhone Number

Current Address:

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Company Name (if applicable)

Type of Applicant

Other

Purpose of Relationship / Intended Use

DRIVER LICENSE INFORMATION

Is your driver license currently valid and unrestricted?

Have you ever had your driver license suspended, revoked, canceled, or restricted?

If yes, explain the reason, date, and current status:

Do you currently have any outstanding traffic warrants, unpaid traffic citations, DMV holds, or unresolved licensing requirements?

If yes, explain:

Have you held a valid driver license continuously during the previous three years?

MOTOR VEHICLE RECORD AND DRIVING HISTORY

During the previous five years, have you been convicted of or entered a plea involving any of the following?

If any item is selected, explain:

Have you been involved in any motor vehicle accident during the previous three years, regardless of fault?

For each accident, provide: (Date, At Fault or Not at Fault, Injuries Reported, Vehicle Towed)

Brief Description

Do you currently have any pending traffic charges or unresolved accident claims?

If yes, explain:

MOTOR VEHICLE RECORD AUTHORIZATION

I authorize RichRoute Fleet LLC and its authorized screening providers to obtain and review my Motor Vehicle Record, driver history report, driver-license status, traffic-violation history, accident history, license suspensions, revocations, restrictions, and other driving-related information permitted by law.

I understand that this information may be obtained from a state department of motor vehicles, an authorized reporting agency, an insurance provider, or another lawful source for the purpose of determining my eligibility to operate a RichRoute Fleet vehicle.

I authorize RichRoute Fleet LLC to conduct an initial Motor Vehicle Record review before approval and additional reviews during my relationship with RichRoute Fleet LLC, where permitted by law and disclosed to me.

I understand that providing false, incomplete, altered, or misleading driver information may result in denial, immediate termination of vehicle access, or termination of any agreement with RichRoute Fleet LLC.

Applicant Initials:

INSURANCE AND INSURABILITY

Do you currently maintain a personal automobile insurance policy?

Insurance Company

Policy Number

Policy Expiration Date

Name of Insured Listed on Policy

Current Coverage Limits: (Bodily Injury, Property Damage, Comprehensive Deductible, Collision Deductible)

Which platforms do you actively use?

For each platform used, estimate your average weekly trip miles:

How long have you been driving?

Months or Years

Primary Source of Income?

Do you drive:

When do you need a vehicle?

How long do you need a vehicle?

Have you:

BACKGROUND AUTHORIZATION

I authorize RichRoute Fleet LLC to:

I confirm that the information provided is accurate and complete.

Please verify that you are human

I certify all information provided is true and correct.

Signature