ZylinX Rentals — Full Renter Application
Complete this application; submission does not guarantee approval or vehicle availability.
Applicant Information
Full Legal Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Street Address
*
City
*
State / ZIP Code
*
Driver’s License
Driver’s License Number
*
State of Issue
*
Driver’s License Expiration Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Upload Front of Driver’s License
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Upload Back of Driver’s License
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Do you confirm that the driver’s license information provided belongs to you and is current and accurate?
*
Yes
No
Rental Information
Intended use of vehicle
*
Uber/Lyft
DoorDash/Uber Eats/Delivery
Personal Transportation
Work/Commuting
Other
Requested rental start date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Expected rental duration
*
1 Week
2 Weeks
3 Weeks
1 Month
More Than 1 Month
Will anyone other than you drive the rental vehicle?
*
Yes
No
Additional driver notice
Optional Additional Coverage
Would you like optional additional coverage included with your rental?
*
Yes, I am interested in adding optional coverage
No, I decline optional additional coverage
Coverage options and pricing will be provided before your rental is finalized. If selected, the cost of coverage will be added to your rental price and managed as part of your rental.
I understand that optional additional coverage may increase my total rental cost and that coverage details and pricing will be provided before my rental is finalized.
*
Yes
No
Emergency Contact
Emergency Contact Full Name
*
First Name
Last Name
Relationship to Applicant
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Rental Policies & Applicant Certification
I understand that a refundable security deposit is required at vehicle pickup and is separate from my rental payment.
*
Yes
No
I understand that rental payments must be made according to the agreed rental schedule.
*
Yes
No
I understand that only drivers specifically approved by ZylinX Rentals may operate the rental vehicle.
*
Yes
No
I understand that smoking is prohibited in ZylinX Rentals vehicles.
*
Yes
No
I understand that I am responsible for complying with the geographic and operating restrictions contained in my rental agreement.
*
Yes
No
I certify that the information provided in this application is true and accurate. I understand that providing false or misleading information may result in denial or termination of a rental.
*
Electronic Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Full Rental Application
Submit Full Rental Application
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