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Home My WebLink About00-06481 YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must taJse action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiffs. You may lose money or property or other rights important to you. { ! CUMBERLAND VALLEY MOTORS, INC. v. GLENN NESTER AND ASSOCIATES, INC., GLENN F. NESTER and SHERRI A. NESTER ,. '<- ~ ~----- ;\~ ,_" -,-"~.<.:.';::;c_;,, - lit * : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff : CIVIL ACTION ; 0::> - ~I.{Pf COL{:r~ : JURY TRIAL DEMANDED Defendants NOTICE ;'l: i~ !J 1~ YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. :232405 _1 COU~JTY L~W'([R RCrCRAAL S~~VICE Tlio",a:> E. CI.emR3, Cetlrl t,dmiAistFator Ct.",lberland COUllty Ce1:lFtf:19b11Oe aile Cuu,1I,OU3C SEtl:lit"e Carlisle, Penr.1syl\l<Jnil'l 17013-3387 - (717) ?40-6~00 G.vnb. Co. 7J~s;socJ~-{{~U c;2 1:,.b~ /JOL- ~tSD~T Pit /7o/J 7/7- :2.vcr-J/U ,'_0 - -,' "'", , ~,.; . ,;. r '- ._. ~, " ,- - -; ~ .','" . "--A'__:';'~ -e:;,. -,~ -~' ., ""_," i ,_', ''',. :::;,~~,;::,LL:";- .,.,., <0,;! ill :l i:J !~ 1;1 II "I 1.1 ij I:! !j I!j III . c . NOTICIA j ,j !i1 [:j j i;-1 ij 1"1 .1 II ,j 'i I: IJ ,,~ I! II ;.J !i I" [II I:l !:1 I.; I" il; !~ i~ :~ l~ il ,I I! LE HAN DEMANDADO A USTED EN LA CORTE. Si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene viente (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Usted debe presentar una apariencia escrita 0 en persona 0 por abogado y archivar en la corte en forma escrita sus defensas 0 sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previa aviso 0 notificacion y por cualquier queja 0 al/vio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE. SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA A VERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. COUNTY LAWYER REFERRAL SERVICE Thomas E. Cheffins, Court Administrator Cumberland County Courthouse One Courthouse Square Carlisle, Pennsylvania 17013-3387 (717) 240-6200 :232405 _1 ~;'''' ;;"-," , -, """"-~,,, ., ,'-~ -,;,"" ' ' ,-,; . ' . ,- " ~-:"-, r'.. ^''' , - ,,; ~ '-, '. , ,;, ",-,~'- /.-' ,~::~ ,,- ,c _': '_,.,,:;;:;:',':~",_,_~J~~:~i,.~{::: ' c . r CUMBERLAND VALLEY MOTORS, INC. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff v. 9 CIVIL ACTION 'fIp. Mill 'f f'/ f5v:J -r.AM- GLENN NESTER AND ASSOCIATES, INC., GLENN F. NESTER and SHERRI A. NESTER JURY TRIAL DEMANDED Defendants COMPLAINT AND NOW, Plaintiff, Cumberland Valley Motors, Inc. by and through its attorneys, Mette, Evans & Woodside hereby brings this Complaint against the above- captioned Defendants and avers as follows: 1. Plaintiff, Cumberland Valley Motors, Inc. (hereinafter "CVM"), is a Pennsylvania corporation doing business at 6720 Carlisle Pike, Mechanicsburg, Pennsylvania, 17055. 2. Defendant, Glenn Nester and Associates, Inc. (hereinafter "GNA"), based upon information and belief, is a North Carolina corporation, last known to have a business address at 1029 North Lake Park Avenue, Carolina Beach, North Carolina, 28428. Based upon information and belief, GNA filed Articles of Dissolution on or about June 8, 2000. n~ ,_ ~ .,--" ,_ ;'.:-;;,u """~'._, "c"', .Co-_ 'w.~,"_ -:<0.- -- /- ,-,"~ '.; ,,~- _.___,' ""->-,'X'_5';, ~:'_:!;~.,;~, {,;:,-:;?-j-,~-:;:;~S-;;;-;:~ '-:_ ..' _ ;"'''':'\',,; .' . r :i i; 3. Glenn F. Nester is an adult natural person whose address is believed to ii: " I; I~ I:) :i I, be 1080 St. Joseph Street, Apartment 2.F, Carolina Beach, North Carolina, 28428. Ii !i :: :; !; 4. Based upon information and belief, Glenn F. Nester is, or at one time was, '" i' president of GNA, a director of GNA, and a shareholder of GNA. , , 5. Sherri A. Nester is an adult natural person whose address is believed to be 1080 St. Joseph Street, Apartment 2-F, Carolina Beach, North Carolina, 28428. 6. Based upon information and belief, Sherri A. Nester is, or at one time was, an officer and director of GNA, as well as a shareholder of GNA. 7. CVM operates a car rental service under the name "Affordable Car Rentals." 8. GNA has rented several automobiles from CVM for business purposes. 9. GNA has outstanding balances due and owing to CVM relating to the rental of several automobiles. 2 ,,-, _ '",_-,~_, ,:_ ~~'";~ -;,;;'" "'~,,~,:_~~;,,_;,,-c,__,___;_' ---- -',,-,-,- ',Y-:~-'o.'d ~_j." '-'.--~-~,-,,';-J_~< "_,,,. ,-._ __ ,,<\_~:'-i;;'::, ~;,-c_ - , - ""<'1 . . r 10. From approximately September 1998 through April 1999, GNA rented a 15 passenger van, identified as license no. NGW979, from CVM pursuant to a series of rental agreements. A true and correct copy of the pertinent portions of each of these rental agreements is attached hereto as Exhibit A. 11. From approximately December 1998 through October 1999, GNA rented a Dodge Durango, model year 1999, identified as license no. NNP127, from GVM pursuant to a series of rental agreements. A true and correct copy of the pertinent portions of each of these rental agreements is attached hereto as Exhibit B. 12. From approximately April 1999 through November 1999, GNA rented a 15 passenger van, identified as license no. BCP1227, from GVM pursuant to a series of rental agreements. A true and correct copy of the pertinent portions each of these rental agreements is attached hereto as Exhibit G. 13. From approximately September 1998 through June 1999, GNA rented a 15 passenger van, identified as license no. ZF27096, from GVM pursuant to a series a rental agreements. A true and correct of the pertinent portions of each of these rental agreements is attached hereto as Exhibit D. 3 . '.,b:-H"- "~,, :"-,>_o~,,_ir - ,-. '--r'-" v"t,~", ',., _,',f_ ';;;" '.-,_,'k .'-,,';"',i;':i{;i.;;;::';-~<"~~~":~-\i'--;,",;,; . """'OCi""-',; I I I I i 14. From approximately December 1998 through June 1999, GNA rented a 15 passenger van from CVM, identified as license no. ACS2599, pursuant to a series of rental agreements. A true and correct copy of the pertinent portions of each of these agreements is attached hereto as Exhibit E. 15. From approximately November 1999 through May 2000, GNA rented a 15 passenger van, identified as license no. BXY51 05, from CVM pursuant to a series of rental agreements. A true and correct copy of the pertinent portions of each of these rental agreements is attached hereto as Exhibit F. 16. A copy of the reverse or "back" portion of a standard rental agreement is attached hereto as Exhibit G. 17. GNA currently owes $37,991.05 to CVM in relation to the six above- referenced automobile rentals, including finance charges and charges for damage to the above-referenced vehicles as indicated on the rental agreements. 18. Glenn F. Nester, on several occasions, has represented to CVM that the outstanding balances would be paid in full. 4 ,.'0 " " ". . -.', ,.;",;.--" ~". -~'-";." ""~"~"_''''',.'--", "",.' '.'~, ' ,,',,-"-'~'" .&- -, .., ;;~:::.:. ",,'1; 0,,' '." ~ t;'~;. '" ,~;;;:~ ::.lj.;'<'", ~,' C,'" ~.",'. F'" '.:: , 19. Over a course of several months, Defendants engaged in a course of deception to delay payment to CVM and stall possible collection proceedings by CVM against GNA for the outstanding balances. 20. On several occasions, checks sent by GNA and/or Glenn F. Nester and/or Sherri A. Nester to CVM for payment of the above-referenced outstanding balances could not be deposited or collected for payment by CVM. 21. Based upon information and belief, GNA and/or Glenn F. Nester and/or Sherri A. Nester stopped payment on checks to CVM. 22. Based upon information and belief, GNA has recently filed articles of dissolution with the North Carolina Department of State. 23. On several occasions, Glenn F. Nester and Sherri A. Nester made personal guarantees to CVM for the debts of GNA. For example, Glenn F. Nester had promised to sell items of personal property to satisfy the debts of GNA. 24. Sherri A. Nester had given CVM a copy of her own personal credit card to cover the debts of GNA related to the vehicle rentals. 5 v_,' ,,-_ "-,_" '"__-' _~~---,"""' __'~ ,-_;,~,',," , ,)^~~, '--"~--'--, -~ , ", :,';,c ,-~~,;',.'.', :.-' - ~-, ,~,:,;j:; ;";;~;~~i:~:-~~;,~ '-d'k'_",'__ ,__Co"~ -J 25. CVM has made repeated demands upon GNA, Glenn A. Nester and Sherri A. Nester for payment of the outstanding balances. COUNT I CVM v. Defendants Breach of Contract 26. Paragraphs 1 through 25 above are incorporated herein by reference as if fully set forth. 27. Pursuant to the rental agreements attached hereto as Exhibits A-F, rental payments for the above-referenced vehicles are past due. 28. Several of the vehicles were returned to CVM with damage, as noted on the rental agreements. 29. Additionally, several ofthe vehicles were returned late, also noted on the rental agreements. 30. The outstanding balance due and owing from Defendants for the aforementioned rental vehicles, including charges for vehicle damage, is $37,991.05. 6 " >--, '" -" _ '-,--'- -, ,-.,- -~ ,-" u~'"__ ':'d~', __ '-:.,-_:, 0"" - - - '-, -, --', ----,--,-, '"_:~'__.",\._"_",,,'-_w.;,-,-~-,--: ~, k;;: ;,"-,;,;,),;;'''''. ','__d-___' --,-' -.~,,,c_ " -,' { ,----'.' - -~--' --,-' - , -- '-"'~--,,~' "",-k' ,,;"~, 31. CVM has made repeated demands upon Defendants for payment of the outstanding balance for the vehicle rentals and vehicle damage. 32. GNA is liable to CVM for the outstanding balance pursuant to the written rental agreements between the parties attached hereto as Exhibits A-F. 33. Glenn F. Nester, as shareholder of GNA, is liable for the debts of GNA to the extent that GNA is a dissolved corporation. 34. Sherri A. Nester, as shareholder of GNA, is liable for the GNA's breach of contract to the extent that GNA is a dissolved corporation. WHEREFORE, Plaintiff, Cumberland Valley Motors, Inc. demands judgment in its favor against Defendants, Glenn Nester and Associates, Inc., Glenn F. Nester and Sherri A. Nester in the amount of $37,991.05 plus interest, costs, attorneys fees and such further relief as this Court deems appropriate. 7 ,~, , -- , '- "'-' ,,' ':'._-,--,;"-,:,:-,-::-,. -=--,-- c",-",,_,, -,iJ,:>,,"4< - ,-\,~_,;,',_ili;,~,--,- ;<.,", _"0'-"--'_,'":;- ~ ,-;> ~" COUNT II CVM v. Defendants Uniust Enrichment 35. Paragraphs 1-34 above are incorporated herein by reference as if fully set forth. 36. CVM conferred benefits upon Defendants by renting vehicles to GNA, as more specifically described above. 37. At all relevant times, CVM conferred such benefits with the reasonable expectation of payment. 38. Allowing Defendants to receive such benefits without payment to CVM produces an unjust result. 39. Further, as more fully described above, several of the rented vehicles were returned damaged. Defendants have not reimbursed CVM for such damage, as justice demands. WHEREFORE, Plaintiff, Cumberland Valley Motors, Inc. demands judgment in its favor against Defendants, Glenn Nester and Associates, Inc., Glenn F. Nester and 8 '-:'-' "-,' . "-"':<::k'ej ,-" '-'Ort ~~ -' " -. " . .' __ 0 , ~ ,_" '':~"~_-,, 0'-,,-._,",' k. '. -, ""'1 '. ,._ '_"'-;"--"_4~' 'k-' ~ ,,= -- Sherri A. Nester in the amount of $37,991.05, representing the reasonable value of the benefits received by Defendants, plus interest, costs, attorneys fees and such further relief as this Court deems appropriate. COUNT III CVM v. Glenn F. Nester and Sherri A. Nester Breach of Contract-Guarantee 40. Paragraphs 1 through 39 above are incorporated herein by reference as if fully set forth. 41. Glenn A. Nester represented to CVM that GNA's obligations to CVM were guaranteed by him personally. 42. Glenn F. Nester indicated to CVM that he would sell his personal property in order to satisfy the debts of GNA owing to CVM. 43. Sherri A. Nester made representations to CVM that GNA's obligations to CVM were personally guaranteed by her, giving CVM her personal credit card as a guarantee for such debts. 9 . ""~ - .'. - "' '~-,;;-,,^,-/.-->;,.,-, ,'- , -~, <~" ".-"C,,'_.," -,.;, ;'-''' '.---.<-'-;,~~,":'::";~:'<_' ."il.., ~-, ".~ ___~ - .:';---" 44. Glenn F. Nester's guarantees to CVM for the debts of GNA inure to Glenn F. Nester's benefit. 45. Sherri A. Nester's guarantees to CVM for the debts of GNA inure to Sherri A. Nester's benefit. WHEREFORE, Plaintiff, Cumberland Valley Motors, Inc. demands judgment in its favor against Defendants, Glenn F. Nester and Sherri A. Nester in the amount of $37,991.05 plus interest, costs, attorneys fees and such further relief as this Court deems appropriate. COUNT IV CVM v. Defendants Fraud 46. Paragraphs 1 through 45 are incorporated herein by reference as if fully set forth. 47. As more fully described above, GNA is liable to CVM for payment of outstanding balances related to automobile rentals. 10 ,'-- , ,.~-",- ,-- ,: ',~,;,.-" .-" '^', " '-'0'" , '-,: .-, _ , n, n-_': __ :_~.;' -,~,',',~"Ji...""""."," n, ---.,:", ,-_:--'--,,---- , "" '''''',',c..,''?-.-_ --~--",'~ 48. On several occasions, in response to Plaintiff's repeated demands, Glenn F. Nester and Sherri A. Nester made representations to CVM on their behalf and on behalf of GNA that GNA's outstanding balances would be paid in full. 49. On several occasions, CVM received checks from GNA for payment of the outstanding balances, but upon attempting to collect payment discovered that stop payments had been issued on these checks. 50. Further, knowing of GNA's substantial debt to CVM, Defendants filed Articles of Dissolution for GNA. 51. Based upon information and belief, by making false representations to Plaintiff and by sending Plaintiff checks which could not be cashed, and by attempting to dissolve GNA, Glenn F. Nester and Sherri A. Nester acted to defraud CVM, on their behalf and as officers of GNA. WHEREFORE, Plaintiff, Cumberland Valley Motors, Inc. demands judgment in its favor against Defendants Glenn Nester and Associates, Inc., Glenn F. Nester and Sherri A. Nester in the amount of $37,991.05 plus interest, costs, attorneys fees and such further relief as this Court deems appropriate. 11 '';'"C'j,';"- DATED: f~ iP""~r Q~ '2.0'il ,'-, . ',- "','~- ,.-~..;-- ,C,~"__,,,<,,-_: -_;')::;'~":.Si,;," '-'''-'t'';--n-- ;- -~,,'" METTE, EVANS & WOODSIDE By: A4'4/f. ~- ~~AD A. GHIASUDDIN, ESQUIRE Supreme Court I.D. #83925 3401 North Front Street P.O. Box 5950 Harrisburg, PA 17110-0950 (717) 232-5000 Attorneys for Plaintiff .", "'i _:,,-,",J'~';'i'~,_,,\":.,;";,',{,'"- i;C_"-~;~/';:',:;;'~;:;,,"i' ~',_.;.,~~,__,__ '\: VERIFICA nON I, Garth Ullom, have read the foregoing document and verify that the facts set forth herein are true and correct to the best of my knowledge, information and belief. To the extent that the foregoing document and/or its language is that of counsel, I have relied upon counsel in making this Verification. I understand that any false statements made herein are subject to the penalties of 18 Pa. C.SA 94904 relating to unsworn falsification to authorities. DATED: Jt/!oo ;/~~ Garth Ullom, President Cumberland Valley Motors, Inc. :232405 _1 ..1&ti................-...~.~~..."=....~_IiII.~ " ~,~ -1:1- = ,,~~~ ~-~" ~ "~-~.- 0' ~"-'jllll" ~ - 'Ii ~'lSIi\J' :'~'Lllil,Ugi ',' .., "-',. RENTAL AGREEMENl''-'l CUMBERLAND V ALL::ty MOTORS 6720 Carlisle Pi (e MECHANICSBURG, PA 17055 (717) ,691-1880 800-382,1436 \^)\~ \\ 1\ ~ L\- - REPLACEMENT CAR NO 0RfG.(S \d- 0 \ : q'F;E\'S\1::.,;,b L 1\ .1 _~M:j_q, q ODO:t"ETER \ 8 'J q 2: ~ETER\'l '4-G,,c; Dif) A1 ()E 'Aq ~ :3~ ~N;A~ r,.: 640816 ( REA(~~U(,6 A.~L.\....I+,7.J:; - '\e. HOMl,t"IJS~ '1F-r..<,c(c.., + lAl">('" ~ -a \\ q CITY 0- \' 4.6 TE~:, ~ .~p~ OR1V~~{}G~kb'd.u 4- ,-" \~617~76 B,RIll Ofi ~ /: C. SOCIAL secUR,1TY NO. HOME !HONE /: LOCALfONTACT AOOR~~ t l .. _ PHONE L_"'hV'\ '-"\\6 '"t~P.l~5~ E&)~ ".. Ne6icL A~,. . q \7;~\D(o 15 ~( '-~ MAKE-MODEL.YEAR.COLOR LICENSE NUMBER ODOMETER IN ODOMETER OUT MILES DRIVEN <6~6 MILES " ;"" ALLOWED , CITY STA.TE ZIP I REFERRED BY ~ QATEQUE - . ~HARGEABL.E, EXPl, RATlON.. OF.AG. ."R._EE._ M ~ MILES ~D-- \',~; "~ _ ." . . ' GAS OUT IN Miles @ , e $' f Hoo~ @ $ $ I Oays@ $ $ , Weeks @ $ $ ",_, Monlhs I @ $ '1cC-:>'VU Tatar Tilne and Mileage Charges $ VI..!'- rm) $ , $ , , , , - ' ~uv ',(.....'~k. $ EMPLOYER'S ADDRESS . I will not under any circumstances surrender the use of the rented vehicle to any person other ttlan Ihose listed below or in Paragraph 6 of the back of this agreement, Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. If none, print NONE across this section. E E , 14 V4 A;\\L ~"':~!I:~ \ (0) (t1(~~~! ;.~Bli : ~ ORIVE!P-'I!CE'!-'ENUMBER A, STATElCOUN] Y EXPlRATlONOATE ~) F t.r,'t''('\'('\ I\J .- 't ~ - '.r j' / - Gas (Taxable) ~~: PHYSICAL DAMAGE AIVEA =rs'S PHYSICAL DECl,f'ES - Cl.., reACCEPTS DAMAGE WAIVER x " RATEs \3.~ PERDAYS~PERWEEK x (NOT INSURANCE) By my initials, I accept or decline Physical Damage Waiver at the rales listed above. Sub- Total If I decline to purChase the Waiver, I accept full responsibility for loss by collision or comprehe~ Sales Tax or Surcharge "7Diii7:: sive damage, regardless of cause, up to $ \ C:f..J ~--' per OCCurrence, which may be Gas (Non-Taxable):J... -.=,~ charged to my credit card shown befow. CfCDW (Non-Taxable) Accepting reduces my responsJbility to $ - r;" - per occurrence, which may be charged to my credit card shown below. . - I t,J.;;',o PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. !:J..Dv 0<;." Y1 Pr r' TC.1.. ~ PERSONAL ACCIDENT INSURANCE (PAl) ~ initiafs, I a. c...c_~pt or decline enrollment for Personal Accident ~ PERSONAL ACCIDENT DECLINES Insura . acce""t. I understand and aCknowledge thal cover ACCEPTS INSURANCE is at Ihe rate~ ~ . ted an~ _~hat I have read tne cer' . of insurance furnished "', ~..,rior 10 rental. $ $ $ $ , - - $ RATE s PER DAY PER WEEK X Pt::RSONAL ~S COVERAGE~~ ':..~'7 By my initials. I ~r decline enrollment for Person ffects ~ol{er aa. If epl, I understand and aCknowledge that cov e DECLINES is at t es indicated an, d Ihat I hlfvelread the certificate 0 ~ACCEPTS l- i nce turnished by dealer prior to fe~al. Sub-Total ~ RA~ES ~DAYS ~PERWEEK X ~.fundFor: VEHICL.\~ON~rION ::"'"\~ n~ ~~. SPARE \ CUSTOMER_ OUT '. ' ~ \W ~\ _.';;;r;.~~n Less Deposits I Sub,Total I $ X REHTER'S INtnALS . PERSONAL EFFECTS COVERAGE $ IN RENTAl. WILL. BE PAID BY Net Amount Due $ $ , - $ IUUl -.J"j $ , $ , , Ih~5 Net Due Renter $ 1 WARNING . t have read carefully all driving and use restrictiOns on the reverse side. . I am responsible for all traffic violations and must turn in all summonses upon return of vehicle. . I will report all accidents immediately. I have read both sides of this agreement and agree to its terms and conditions. I authorize you to process a credit card voucher, if any, in my name. ORC AMEX C8/D1NERS THIS IS YOUR INVOICE. PAYMENT DUE ON RECEIPT X~"J\r--- \ rG,~ '~ _'SSIGllATURE EXTEND TO ADDITIONAL CASH DEPOSIT DATE INITIAL.S S VISA M/C OTHER \~}- 'J aJr EXTEND TO ADDITIONAL CASH DEPOSIT . DATE INITIALS CREDIT AUTH NO DATE I TIME AMOUNT AUTHOR.IZED 8~: CHECKED OUT B'<: CHECKED IN BY ADAmSJJ FINAL CHARGF~ ARr::- ~lJR,rF='r.T Tn bllnlT CUMBERLAND V ALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717) 691-1880 ~.~ "~ ,!.o;!w,....... ~~, . ~""" .~" . ,~..... ~ .REEMENT ( RENfJ<e^(ittwAtJ"f01\lIO AZ.CAU1b" HOMEA'5~q ~re.~ levvlt. 2n~' ~\V'G. fl Ol'()tf ~~E~OmJ. BI";i~c:: II ,9-, lOlAl CONTACT AODR~S I :\ ,I, PHONE , I,UVlf\., '1IU-l1S<l.-(}5s'~ ~;tJ';;1I\+ Ne$..kt- k<.1JC. qIO:L~n - O&l~ E\D~l\DDtS k-, \~e.. Rr'n A-vt:-. C;J:Y _ ~. ,.., tTAT~ IIlI!:- :" ..bW~~Y f ~ V,\(')l\C"'\tI ,0"",, ~ ~'-r.,(~ I will not under any circumstances surrender Ihe use of the renled vehlcle to any person other than those listed below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. II none, print NONE across this section. -FZ SOCIAL SECUR.ITY NO. ~~3Lj EXP. DATE I~.;)~.()Q HOME PHONE , GAS OUT IN DRC REJECTION OF UNINSURED MOTORIST PROTECrlON AMEX I am rejecting uninsured motorist coverage under this rental, or lease agreement, and any policy of insurance or ..~f-insurance issued under this agreement, for myself and all other passiBn- gerl of this v.hide. Uninsured coverage proteds me, and oth~r passenger. in thi. vehicle for loss and damages .uffered if injury is caused by the negligence 9' . driver who does not bave any insurance to pay for 10.... and damage.. CBfDINERS VISA M/C OTHER R~nt.r'. (1'''''J'\6~^(l ;1' Signature III r 1 X1 A J Dot.!O ( 10 A<6 CREOIT AuTH NO DATE I TIME AUTHORIZED'BV' jAMourn - ........ ~'" , ~llil,hiiiiliiil~ l:Mlli ~"k<;t@" 800-382-143~Al"-1 \Q(oClt.t REPLACEMENT CAR NO 641,006 MAKE.MODEL.-YEAR-COLOR :D~~ 'qn~EA~ S ~~!,,~~R -. ~t5W - UJiOl ODO;:'ETER ~O~!?, ODOMETER _- DT':~ T~ IN P.' : DAli""''''';) ~ ~: ;r~TE~~1. LICENSE NUMBER ODOMETER 'N ODOMETER OUT MILES DAIVEN 21~d- ,,~. ~, .:2k)( / U -0- p MILES AWlWED CHARGEABLE MILES / '": OC~IVV '" S I , , I :...., ,.. $ $ $ S Y.-S' 15= , I --'- $ $ . ~.' - /VVI,.....;:> Net Amount Due Net Due Renter WARNING . I have read carefully all driving and use restrictions on the reverse side, . I am responSible for all traffiC violations and must turn in all summonses upon return (It 'Iehiele. . I will report all accidents immediately. I have read both sides of this agreement and agree to its terms and conditions. t authorize you to process a credit card voucher, if any, in my name. T:~HIS IS YOUR INVOICE,. PAYMENT DUE ON RECEIPT X 0)1 011 n~liU;t l.t4(}C'~~ RENTER'S SlGHATURI! . EXTEND TO ADDiTIONAL CASH DEPOSIT DATE INITIALS . EXTEND TO ADDITIONAL CASH DEPOSIT . INITIALS DATE CHECKElV\JUTN V: f<1J0 . l~m8:. '''''''''~'l' ADAmSD (o::Il)lll~'" FINAL CHARGES ARE SUBJECT TO AUDIT ;j.~""'~"K. --' - ~.'<,~ ""."L~.. ~I '-. . IlENTAL.AGREEMENT . CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717) 691.1880 800.382.1436 Gas (Taxable) ~~ PHYSICAL DAMAGE WAIVER ~' PHYSICAL DE~ "1 c...:' __ ACCEP'rS DAMAGE WAIVER x 1'\.. RATE $ , ~'\? PERDAY$~PERWEEK X (NOTlNSURANCE) By mYJimtlalS, I accept or decline Physical Damage Waiver at Ihe rates listed above. Sub-Total " If t decline to purchase the Wawer, I accept ful~l3Pf's~ for loss by ColllSlon or comprehen- Sales Tax Of Surcharoe ~ slve damage. regardless of cause, ufc to $ t.l!lL V / tJ per occurrence, which may be Gas (Non-Taxablel.~. #'J7 J'-9-"/' ~~~~gp~~~Qr::u~~~d~;~~~:~~:~II~; ~ow $ -U - per occurrence, which may be r C/CDW (NOn-Tax~~_~') '#' ~. charged to my credIt card shown below I ~ 't-7I7r7 1 --; U' ~PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. IAI {J{ ~ . U ~~s PERSONAL ACCIDENT INSURANCE (PAl) ~:. it. By my initials, I accepl or decline enrollment for Personal Accident ~ PERSONAL ACCIDENT $ DECLINES urance If r accept, I understand and acknowledge thai covera ACC""PTS INSURANCE IS rates Indicated and that I have read tne certifu;aW!"'of .....r insuranc shed by dealer prior 10 rental. I Sub-Total r PERSONAL EFF AGE (PEG) =" By my initials, I a or decline enrollmen Personal Effects . 'PERSONAL EFFECTS DECLINES Cover ae. If ~pl, I understand and acknowle_.i.: ~coverage ACCEPTS COVERAGE is al t es indicated and that I hClve read II ,e c .. te of __vin ce furnished by dealer pr\ortor~t2f. ~SUb-Total ,~ ~ RATE $ PEA. DAY' r PER WEEK X Less Refund For: VEHICLECO~~ION '_ ~ C\ tV \ \..VAY \ _ SPARE CUSTOMER . - .'- OUT - - ~ '^...u:., -" ~ '1"$.'("\ ,/~.K, INITIALS Less Deposits ?5i., M e. ~ENT (f'R7ifI l '\" -;: l'r~,~~ A.,...,., II - ---"c... HOM~D~~~ ~re.6-t-' Li"\ . CITYK:'.\o._ ST*E'I.. ~ . DRIV\RD'3N~b9c;4- STT"'f.. ~~~~ SOCIAL SECURIlY NO, \-..v~ "'v-8 L~L CONTACT I E~L'K RIl , '''', I'''.ONE , _ If ~ ft q,C.:l\.,\"'-t\ Dw '0 E,";L~~SA~\RY:'$..... Pu-\~ Av-:.-. Ir -:c ("t _. \ $TA~ic. "b\.f~ERREDBY :u..,Q\ \C\ ., SQ6~ \.Q.Qt;;& HOME PHONE ~ \DD~1Sw 055::1 PHONE I will not under any circumstanc~s surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. If none, print NONE across fhis section. GAS OUT IN ADDITfqNf\lAENTERI'{~ D' \ D ( a\,y\>"r\J ORtVE':!'S Ice!ISENuMBER -r E 14 I> .. ~vI" ~~E.P;';~' r> ~T~'Jli STATE/COUNTRY, jTlON iTE X i\EKTBrS IHITlAL$ RATE $ PER WEEK X AY IN RENTAL WtLL BE PAlO BY 1~5' DRC REJECTION OF UNINSURED MOTORIST PROnC1TION AMEX I 8m reiecting uninsured motorist coverage under this rental or lease agreement. and any policy of insurance or .elf~insur.nc. issued under this agreement. for myself and .U alhel, passen- gers of this vehicle. Uninsured coverage protecfl' me ~nd other passeng&l's in this y.hiel. for Ion and dam.... 5uffered if injury is caused by the negligence of . driver who does not have any insurance to pay for 100Ies and damages. CB/DINEAS VISA MIC OTHER Renter's c...~,.-" Signature Io......J ~I\ c.. lWe \a/~ pt) CREDIT A\JTH NO 1 DATE AUTHOfUZEO BY: . I TIME I AMOU!n REPLACEMENT CAR NO. MAK~MOOeGYEAR~LOR LICENSE NUMBER ODOMETER IN ODOMETER OUT MILES DRIVEN 'eo oLt ..;.. . .""T MILES ALLOWED CHARGEABLE MILES ~ E 14 Miles @ Hours @ $ Days @ $ Weeks @ $ Months , @ $, Total Time and Mileage Charges V. % Net Amount Due lllll" ..... "' -- "-""'--~'ill,",lliC:>_,,'"",,"'"Ll~~""'-,":"'-"'"' O(C-~i\\\4m6 .641392 O,"G,C~'b \ I~~~ L N~ ~"tE:cn q """\tETER I~ u.. GOd- ODOMETER 1"'1 t1".. - - OUT, 'd-~ \-r> D1E ANj ~'~ '" PlRA ~ ~.~ :TeDUE. -', NJ e $ $ , $ I $ , $ q..Q[6J . $ ~r-v-. $ I $ , , I , , , $ ""I.."ll f"I:QQ- $ ~:--''''~ $ , $ $ , ~ ~ $ $ $ $ $ U' $ $ i'rlb I : , $ Net Due Renter WARNING . I have read carefully all driving and use restriCfions on the reverse side. . I am responsible for all traffic violations and muslturn in all summonses upon return of vehicle. . I will report all accidents immediately. t have read \)Oth sides at this agreement and agree to its terms and conditions. I authorize you to process a credil card voucher, if any, in my name, x~~ EXTEND TO THIS IS YOUR INVOICE. PAYMENT DUE ON RECEIPT ~\- r:.u..r...-....... RENTER'S SIGNATURE AOOmONAl CASH DEPOSIT . DATE INITIALS EXTEND TO I :DDITIONAL CASH DEPOSIT DATE CHECKED OUT BY: CHECKED IN BY ''''1'''''.'1' ADAmSIJ (1Q'l1232.'" FINAL CHARGES ARE SUBJECT TO AUDIT INITIALS ~;iIl!~j,:.iII"~ . RENT At. AGREEMENT ~~~,~ ~~ ~ "", ~~~'."~... l,-. , -jiliilillW - CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG, PA 17055 (717) 691-1880 800-382-1436 GAS OUT IN , E E ~ y, Aa\rENTEct~:O\W\ rID'EP(t)~\\~ 2e;~: ~ DAIVEA 5 LICENS""II"l\"''\ A ISTATEICOUNTAY EXPIAA~ "-;lE C. F ~ .Y a- , \J I I - Gas (Taxable) ~l PHYSICAL DAMAGE WAIVER ~ PHYSICAL DE~ Ci - . - ACCEPTS DAMAGE WAIVER x .,.. RATE $ \ '0 'iOPER DAY $~ PER WEEK X (NOT INSURANCE) By my initials. I accept or decline Physical Damage Waiver at the rates listed above. Sub-Total If 1 decline to purchase the Waiver. I accept full r;if~sjb)lity for loss by collision or comprehen- Sales Tax or Surcharge -~ 1. sive damage. regardless of cause. up to $ '(lll... L. per occurrence. which may be Gas (Non.TaxableL:..).l.,./ )/ l/J {1- ~ charged to my cred.t card shown below,.. C/CDW (N ~T bl) , II Accepting reduces my responsibility to $ - C~ _ per occurrence. which may be I on axa e charged to my credit card shown below. . .. :J I. PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. lot _ f I f I /J/.f111 f./Tll . t/i '::m~;s PERSONAL ACCIDENT INSURANCE (PAl) ~ ' I (i ............. By my initials. 1 accept or decline enrollment for Personal ~ PERSONAL ACCIDENT De~""$ Insurance. If I accept, I understand and aCkno",!l~d.~ erage ACCEPTS INSURANCE ~-~~ is at the rates indicated and that I have rea~ certificate of -. .. ~. ranee furnished by dealer prior to ren I Sub-Total RATE $ P $ PER WEEK X I PER~F OVERAGE (PEe) ~ By my in~ acc.eJ;lt or decline enra r Personal Effects CO\l~lf I accept. I unOefstand and acknowl t coverage DECLINES ~ lhe rates indicated and thai r h....e,;read tne c~ -01 ACCEPTS ~ 'Insurance furnished by dealer prior to rE!:iltal. --..... Is b $ t ............ u -Total RATE'" -PER DAY $ P~ x _______ess Refund For: $ VEHICLE.:DNDITIO,_i '~.,,:~,,",~"-1'i~ ,.. -,,'I ~,. CUSTOMER .. ..' $\' OUT ~, - O!~. INITIALS less Deposits $ '" _ l. \NO\ IN 00... . ,0;;;;... RENTAL WILL BE PAlO BY ( RENTII'V~'(7) '. A \ '.' A U(,D' ['c"'\12:1n'lo l'2U.a;.~c:. HOMe,--lr..J<_ ,... . ro ~Cb T- L.. r-.e. .ll-. ~ \\ OX CITY D",\\ct6 STA~~ bt;~?:\l'E DAIVER'~C~":'~OL:.. <""\ ,_, , STo\l '-, .... .... 2:' DAlE \U",\rJ \U"'T '" \..,L-...1b .C1C;) 1"1 ~~.s-k;K SOCIALSECURITVNO,. H<JMEPHONE ., L CAl CONTACT AODAES~ _ ~ \. PHO~~ -.... '('\V'" q ID "'ht;K 056-l EM'{;..Y"N A q \ () 4L\- to;:, ~ -; p:; E\O~S(;~DDR^SJ. L.~\)"t f'~ Pc...r\~ Ave- CI~ _ \. r:..... STATE \ J'P /'\ ;,L."J"fR)iI\D)I.l: l..,.o(A("Ol\'\"\!.o,', .r\" !\J(~ r-'.>-KUr"'/""'~ I will not under any circumstances surrender the use of the rented vehicle to any perSon other than those listed below or In Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver 10 violation of Paragraph 6 is prohibited. If none, print NONE across this section. X REHTER'S 1ttIT1M.$ irYJh' , REJECTION OF UNINSURED MOTORIST PROTEC'I!ION DRC AMEX 1 am reiecting uninsured motorist cove...ge under this '1-ntal'. or lease agreement. and any policy of insuranett or 'lelf-i~suranC8 issued under this agreement. 'or myself and aU ,other: pas-sen. gen of this vehicle. Unimured cOYerage protects me and other passengers in this vehicle 'or lOll Ind damages suffered if injury is caused by the negligence of II driver who doe. not have any insurance to pay for louel and damagss. CBfDINERS VISA MIC OTHER Rent.r', .', '" F' \ .,&> Signature Sh ",'<"\C4r'\ \ \ ..... Dote \ ,6P6. CREDIT AUT~_ NO I DATE I AMOUNT I AUTHORIZED BY: I TIME REPLACEMENT CAR NO MAKE.MOOEL.YEAR-COLOA LICENse NUMBER OOOMETER IN ODOMETER OUT MILES \ r-. r DRIVEN l?to MIlES ..., ALLOWED ,.-r CHARGEABLE MILES ~ - ''''-.'' ~-"h ~""'~Il!llIlll-"IIi"""' .~~ ,_~<,,<, 641574 ORIG.y 'l\':.l e, \ M~MF1L'V It; . \-'~ i '1\j~\ljA-q -, q ODOMETER (') r "lLLr, ~ IN f7'.\[} ,\,-,\,-, OOOJtn.ETER rJ..'>r.(i5'ri.... ~N/1lj'~q b~ OA\iFf~~ DATE DUE RATIO OF Miles @ Hours @ $ Days @ $ Weeks @ $ Months\ @ ~"'-:R5 Total Time and Mileage Charges . $ , $ , $ , $ , $ (!j,.., $ CI. ';1 1=\ yv_ $ I S , PERSONAL EFFECTS COVERAGE Net Amount Due , , , 1 , , $ ",\:;:,I~ r...r, $ "V:z.'-~ $ , $ I ~ --- $ $ $ $ , I , , I : ,',..l '" $ $ Net Due Renter WARNING . I have read carefully all driving and use restrictions on the reverse side, . I am responsible lor all traffic violations and must turn in all summonses upon retunt of vehicle, . I will report all accidents immediately. I have read both sides of this agreement and agree to its terms and conditions. I aulhorize you to process a credit card voucher, if any. in my name, -' TNIS IS YOUR INVOICE. PAYMENT DUE ON RECEIPT ca~\- GL\-\6q.Q x .......1 E)qENO TO RENTER'S SIGNATURE A-ODITIONAL CASH DEPOSIT , DATE INITIALS EXTEND TO ADDlTIONAL CASH DEPOSIT . DATE INITIALS ~P\Y ("'1"''''1' ADAmSD laolllm..," FINAL CHARGES ARE SUBJECT TO AUDIT CH IN BY. 0/\ "~;j!~"",,,,,,,ic~';~II~:~~'""" -~~~"........' ~~ .-....""~ ~ -. RENTAL AGREEMENT ~ ~.b._~~ 1liJ1f.~"'~~ . -...._,~~"'f'~ CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717) 691-1880 800-382-1436 . . MILES ALlOWED ~H~~rsBLE, EJ<l'IRA,DATE~~'~, GAS OUT IN Miles @ -".. "It $ I Hours@ $ $ I EEOays@ $ $ , ItItWeeks@ $ $ , ~WNAL"...~~::''t'~C',,, f\ HO~~E::.._ I'!ATEo;BI~ "V. Months I @ '.I"'h $ G 2~ 00 "'" \\ C7 "",,,,,"Ii ,...0( r'rIt"'\u.:.fr\ 0.- I I "':I(, TotaITime.nrIMiI.....Chara.. $ "\!3<;;" On DRIVER'S LI~E~UI'B" SrATEICOUNTAY EXP1AA~ ~TE (!:: (!) $, , r I V J-!r / / Gas (Taxable) $ I ~ PHYSICAL DAMAGE WAIVER ~ PHYSICAL : DI!QJI'ES , ~ r"" ACCEPTS DAMAGE WAIVER $ , x 'k RATE $ \ ~ .~ '0 PER DAY $ ~ PER WEEK x (NOT INSURANCE) : By my inltials, I accept or decline Physical Damage Waiver at the rates listed above. Sub-- Total $ ~ ~ ~ f::1r) If I decline to purchase the Waiver, I accept full responsibility for loss by collision or comprehen. Sales Tax or Surcharge H/. $ "" ~ 1J~ sive damage, regardless of cause, up to $ I {J1J I . per occurrence. which may be Gas (Non~Ta)(ableO. PV) / U1 Jf $ I charged to my credit card shown below. C/CoW (Non-Taxable) I \.J $ Accepting reduces my responsibility to $ - ~-' -... per occurrence. which may be I I charged to my credit card shown below. I ":") "I. ~ .PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. ~ r ~ I -1m ( ) t7,L/., 771 V .......... ~ PERSONAL ACCIDENT INSURANCE (PAl) ~ ~ (J.I j J ' J....av my initials, I accept or decline enrollment for Person~' . ilt PERSOIfAL ACCID'tNT $ I DECLINES Ins~~. If' aCf~~Pt, I understand and ackn at coverage Al"V':EPTe: INSURANCE : is at the '~e~~..and thai I~ad -tne certificate of ................. I insurance furnishe aler' H'lTrental. I Sub-Total $ \ X RATE $ ---PER DAY PER WEEK x I I "=~~S ~ERSONAL EFFECTS COVERA~C) ~s I ~)' jniti!,!I~. I accept or declrne enrollment for P~I Effects PERSONAL EFFECTS $ : ~o~~r~~e r~t~~CI~~~aleucrd:ri~t~~tar~#~~~dt~~ t~h~ ACCEPTS t COVERAGE : Insurance furnished by dealer pnor 10 renfal ""- Sub-Total $ x RATE $ ~ PER DAY $ PER WEEK X ~ Less Refund For: $ I ... VEHIC'KCO~DITION_E>:.~...~","", "'"' .eo'>,' SPARE CUSTOMER~$\r"f;r,;.:. ,rA..", OUT . y~. . ';"c..'&~~G\UI""\\ JACK 0,.. INITIALS less Deposits $, -.-- IN 5:4'A e., RENTAL WILL BE PAID BY IO:i~ ( RENJfCl (PRIN,\ .- \ A t.\\'TO('O A\/""\;o",\O ~<:.. KOMfftI~" ~ ,d!::7 t L.a.", ~ ~ Q\ \ q CITY PC\ \\ o,-b STT' "'/.. l$0t3\fE ORMR'6~~e&o'4 ST~ . \'J.'~~ B1R;llI OATE r ,.. SOCIAl SECURITY NO. ,/OC/~~ . t~C~T() ADDRE~ \0 4-58 65N6 ~ E"(;.<fvJ\; A- q \ 0 ~;\NE r,(;," 0:; E\?1Y~~rD~. \ ~ \"'e. rC, ,-\L.. A ue., cL.o.Q:A, ",c. Ii S~AT~ l\fc.. ~1~~~R HOME PHONE I will not under any circumstances surrender the use of the rented vehicle to any perSon other than those listed below or in Paragraph 6 of the back of this agreement. Opera.tion of the vehicle by any driver In viOlation of Paragraph 6 is prohibited. If none, print NONE across this seclion. .~ DRC REJECTION OF UNINSURED MOTORIST PROTECTION . AMEX I am reiecting uninsured motorist coyerage under this rental or lease agreement, and any policy of insurance or ..If.insurance issued under this agreement, for myself and .n other passen- gers of this vehicle. Uninsured coverage protects me and other passengers in this vehicle for loss and damages suffered if injury is caused by the negligence of . driver who doe. not have any insurance to pay for lossel and damages. CBIDlNERS VISA MIC OTHER ~rgn:::~~.5\1'r\~~; \ e 00'0 tJJ bf\C1 TDATE IT'ME I AMOUIH AUTHORIZED BY: CREDIT AUTH NO 641725 REPLACEMENT CAR NO. IOR",.CCf\~O\ I~~\~~ 1S~.\;j=-~., q ODO~ETER ) 0') /9 ~ OllOMETElj 11'\ r Ilr. ":Z.. OUT . Irl.~ J O~r~EIN~IO b~ DA~":r~,\C\ C:PAi MAKE.MODEL.YEAFl.cOLOR LICENSE NUMBER ODOMETER IN ODOMETER OUT MILES DRIVEN 1J.."v\ ~ - Net Amount Due $ Net Due Renter WARNING . I nave read caretully all driving and use restrictions on llie reverse side. . I am responsible lor all traffic violations and muSllurn in all summonses upon retum ollJenl~. . I will report aU accidents immediately. I have read bOth sides 01 this agreement and agree \0 its terms and conditions. I authorize you to process a credit card voucher, if any, in my name. $ THIS IS YOUR INVOICE. PAYMENT DUE ON RECEIPT X P)\Ii\~ Ov-\CC \ -~ r\ \\ ~ ~ RENreR'S SIGNATURE AOOITIONAL CASH DEPOSIT . EXTEND TO DATE INITtA.\.S EXTEND TO ADDITIONAL CASH DEPOSIT . INITIAl.S DATE I~MTBY: CHECKED IN BY ''''''''~'l' ADAm!;D """ .'"." FINAL CHARGE5; ARF ~"R.'~"'T Tn ^'tnlT ~'li~"'"'-"'"Iii-lO!i>.""'---~ .,. 'ri ~. -.._,~"~ ~ ~.'~'~<o" I _. ___ _~~ "~. "fl~'_ ~ - 1~~*,,,,,Wlli,,"'~""_='~_:'~"L-"""-' !!iiill'~ .' ,. . RENTAL' AGREEMENT c rJb CUMBERLAND "ALLEY MOTORS bf\? + ~ ' MECH~~I~~~~~I~.P~~ 17055 O~ # (717) 691-1880 800-382-1436 ~D ,1. 907 , , REjf'RI/(T))h.J(O A, \- " ri A~1'. rt.\e. HOM,*", R S ~ \ Cl, \ C-/\ UM ~ La,", c.. C1TYO"'\$;\h TSf1:, DRI1ou~~~./l_ 4- 1T~ B\IAR' ~E SOCIAL SECUR.fTY NO. r:/- .(TO Lhb ,\<,CAL CONTACT L1(\f) E,(;7\R1I4 q \0 1.\-L\-\EC6 D I W)~~ A1\,1ES1-", \\ e:.. fh- \\Ave-. IC;:v \ l?-- ..J_ STtT;/, -:1 i"- t\ --1hREFERREDBV I ( _",or) \,'"'''' u..J.Of) !$L . " ./l\\C\ J:5~ "'J <'I EXP. DATE , ld'aS06 HOME PHONE ADDRESS 0.. 'D "TSf) --0558 GAS OUT IN . RENTER'S IHInALS fSl~~5 NO \(5t~C;YErf\SS lI~?,';~pMBi~ , '~I\/. 'e\' . O\~ JJJG.WR~ ODO~ETER 3lDi(P OllOJ&ETER ~ 1~ \.\ :~~:. ~'~~ ~"l'JRE:~~ ODOMETER IN U-C\ r9. \ \ Q:?.3 ~~ ~L ODOMETER OUT MILES DRIVEN MILES ALLOWED CHARGEABLE MILES B~ Mile Hours @ $ Days @ $ Weeks @ $ Months \ @ - Total Time and Mileage Charges es $ $ $ ~ ~\ $ $ ; ~Ot? lOt"> $ , , , , , , c:> \"'O~ I""ur- $'j1o,~ $ !L"" $ ';;l $ I ...... .- $ , 'PERSDNA~ EFFECTS $ , ACCEPTS COVERAGE : I _____ I Sub.Total $; . _ess Refund For: $ ~ I ,,_ CUSTOMER '. .' . $ 'Ao.Tl LI' \ J INITIALS Less Deposits $ I , ,roF Net Amount Due $: ORe REJECTION OF UNINSURED MOTORIST PROTECTION AMEX I am reiecting uninsured motorist coverege under this rental 'or leas8 agreement, and any policy of insutan;. or self.insurance issued under this agreement, for myself and an other passen- gers of this vehicle. Uninsured coverage proteds me and oth~r passengers in this vehicle for loss and damages suffered .f injury is caused by the negligence of II driver who does not have any insurance to pay for tosses and damages. CB/DINERS VISA MIC OTHER ~~::;~~..c:-j, v r\O/")\-'\\ e Data 2J i'P f\~ CREDIT AUTH NO DATE I AMOUf~T I AUTHORIZED BY TIME $ Net Due Renter WARNING . I have read carefully all driving and use restrictions on the reverse side. . I am responsible lor all traffic Ifiolations and must lurn in all summonses upon relum of vehicle. . I will report all a.ccidents immediately. r halfe read both sides of this agreement and agree to its terms and conditions. I authorize you to process a credit card voucher, it any. in my name. THIS IS YOUR INVOICE. PAYMENT DUE ON RECEIPT xP,\~o-.. \ - '.I'\- GI..\\3Cbt EXTENO TO RENTER'S SIGNATURE AOOITIONAl CASH OEPOSIT $ INITIALS '; DATE EXTEND TO ADDITIONAL CASH DEPOSIT $ INITIALS DATE C~MUT BY ~,^IN BY ''''1'''''''1' ADAmSD (l3l,lll"'" FINAL CHARGES ARE SUBJECT TO AUDIT :i-~l""'~",-'-'~~~lJlIilIII' ,__, '~~UN'~I.~- . RENTAL' AGREEMENT lIlIliIli - ~,,'-"'""""'"- . CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG, PA 17055 ~' 641501 ORlh~ \ ~efLrro~c. r-, uCr\1AJrJ _\g. ~ OOO~ETER \ C>5B ~ ~r~7 OA, Aloe. ~"~ MILES n..r..,...,., ""\'T ..I7Ju E.C\ ALLOWEO ~ ,V' "'C>' ~~ OUTIN~ Hours@ $ $ , E Days @ $ $ , Weeks@ $ $ , Months \ @ $F'.:.9:>r1'~ $ 'Or.7 Tolal Time and Mileage Charges $ ~ n~ $ , $ , , , , , $~,~~ $ ,r;. ',i:;7"t $ , $ , .-L- (717) 691-1880' 800-382-1436 Gas (Taxable) ~INlT 'S- PHYSiCAL DAMAGE WAIVER ~ PHYSICAL OE .-z. C C:.I""\ Lr: ACCEPTS DAMAGE WAIVER x RATE $ \ O. q:::J PER DAY $ ~ PER WEEK x (NOTlNSURANCE) By my initials, I accept or decline Physical Damage Waiver at the rates lisu~d abOve. Sub--Total ~ If I decline to purchase the WaIver, I accept full re$pon$ibili~for loss by collision or comprehen- Sales Tax or Surcharae ':"2 sive damage, regardless of cause, up to $ \ t::Jl:J) m per occurrence, which may be Gas (Non-Taxable).!l. .~O ,,\ charged to my credit card shown below. .,..-._ CtCDW (Non-Taxable) Acceptmg reduces my responsibility to $ - It::i" ILl .i - per occurrence. which may be I charged to my credit card shown below. I PHYSICAL DAMAGE WAIVER IS NOT INSURANCE, ' 1:.1 .t'J(;J I }.,.... "''''''''' PERSONAL ACCIDENTlNSURANCE (PAl) I ":W"..Y ,I I ~v my initia.ls, r accept or decline enrollmenl10r Personal Accident ~ - PERSONAL ACCIDENT DECLiNES . ~e, If I accept, I understand and acknowledge that COlier ACCEPTS INSURANCE is at t~ indicated and that I have read the ce .. e of insurance furniS?ftM.b.v dealer prior to rental. Is T I ub- ota ~E PER WeEK x I I PERSONAL S co (PEG) ~~'8 I By my initials, I pt or decline enl"OUment fo onal Effects . PERSONAL EFFECTS $ I Cover ae ccept, I understand and acknowledge ~verage COVERAGE t DECL.INES is a rates indicated and thai I h~e~f.ead the certif~ ACCEPTS : rance furnished by dealer prior to relUa . ~ S -= I $' , ub-Iota RATE $ PER DAY $ PER WEEK X $ _,.. \ VEHICLEI'QNOITlON L.. --n \ ~n SPAAE CUSTOMEA ~$ \..j I'1.Lo 'H J OUT ) t- M rea-- ~d 1 JACK O.K. INITIALS less Deposits $ I C;.~_~. $ ',' ~cn,-", Net Amount Due R7_ ~-F~~\\",,1J -, r HOME OCjE'f10 S~. ~JCrl:1r. ~. ~..,J ~F CITY ~,,\~~ -,1 ,ST~TEf ar-, ~ 'fi OAIVE~ L E'i9......." r ST~ ,,\, EXP, OtTE ~r r{Jl'\11O ' " 1\'\\"0, ,l'H i\E \ ~ SOCIAL SECl1A. ,NO. _ HOME PHONE L~~I'" "e k leb\er ADDRESS 'HONE E~E"J A L"I",'" O\\O_..._P~ONE ~ ~s;1 EMYa(~RES~-h< ~ \~e: fc,r-~ A\X... CI>,,- \ () ""iTATE ^ v-Z1P " _ , .1 ~"'RJ:l~O BY ( r."..) \....'1 - - / vt..- t-I.k I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver In violation of paragraph 6 is prohibited. If none. print NONE across this section, JIll E, ~ ~ 1<6 ;. ADDm~tl RENTER NtM,E,.-- ,,- C\\\ nr#A\\~\(N DRIVER'S llCEN~ -NUMBER tJ~EP..HONENO.__ '~E~I'R" "\lr-\\.PA\"")l~ JrNft STATE/COUNTFIY jTJON iTE x RATE $ RENTEA.S ......UI 1.........- till IN RENTAL WIL.L BE PAlO BY l,r:tJs DRC REJECTION OF UNINSURED MOTORIST PROTECTION AMEX I am rejecting uninsured motorist coverag_ under this rental or lease agreement~ and .ny policy .of insurance or self"insurance issued under this agreement, for myself and all other passen" gen of this vehicle. Uninsured coverage protects me and other passengers in this vehicle for loss and damages suffered if injury is caused by the negligence of . driver who does not have IIny insurance to pay for loss8. and d.mages. CBfDlNERS VISA M/C R~nter" 1;f" Af.,f:r Signature ~,rj Date ItA 1<{1 tl OTHER CREDIT AUTH. NO DATe TIME T AMOur<lT -, AUTHORIZED BY ~f REPLACEMENT CAR NO. MAKE-MODEL-YEAR'COLOR LICENSE NUMBER ODOMETER IN OOOMETEfl. OUT MILES DRIVEN \Gq" l\ V. ~--;, '~'_~~lll'4#ii"''''_y''''';' $ UY;. - , $ , , , , $ , $ Net Due Renter WARNING . I have read carefully all driving and use reslrictions on the reverse side. . I am responsible 101 all traflic violations and mlJst turn in all summonses upon return of vehicle. . , will report all accidents Immediately. I have read both sides of this agreemenl and agree to its terms and conditions. I authoriZe you to process a credit card voucher, if any, in my name. :HIS;;?La~~RECEIPT- ... V RENTER'S _lURE EXTEND TO ADDITIONAL CASH DEPOSIT S EXTEND TO ADDITIONAL CASH DEPOSIT $ C~ fJ\Y: '''''''''''2' ADAmsu {!IOOII12'..,,, FINAL CHARGES ARE SUBJECT TO AUDIT DATE INITIALS DATE INITIAL.5 -~'" BY ~";;:"1 ~" ~----,~=~ ~" . RENTAL 'AGREEMENT ~. ~, ~ .".,~ ~-i- .~ ~~ lIiMlI ~"""'Ol~""""" .- CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717) 691-1880 800-382-1436 ( RENTE~~7)e \,\V"\ f r-'in ~ V9r'\ l\H ~ \ HOMEADORESS ." ,~, "T'_ \ .0 \DBa 1,J1'. ~ In ot. CITY Gq;,\\'r\" tJ... _\ STA}J C DRI~~~ \c.. ^rr. , Hi' E .~" SOetAL SEGUR.ITY NO. . _ HOME PHONE LO~CON:~ -\P k~ AD~O}JSB~Cj.( E'gL'fJR It- L .. q \0 \ ("......-: 055" g, EM\0;rtt~ N. \...\~ Pe,('\~ ft~)C. CI~ \" _' ~rATEl, ~ ZIP t""I~ ,~ED BY "r - ~i\""" I~... .r\_ I\JL. L ~F .c;( ~ LfP..s< ~ \\ _ \,".06\ I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. If none, print NONE across this seclion. GAS OUT IN """,,," """" x """,,,', INITIALS , DAC REJECTION OF UNINSURED MOTORIST PROTECTION AMEX I am reieding uninsured motorist coverage under this rental or lease agreement~ and any policy of insurance or self.insurance issued under this a9reement~ for myself .nd .11 other passen- gers of this vehicle. Uninsured cover.ge protects me and other passengels. in this vehicle for loss .nd damages auffered if il1iury is caused by the negligence of . driver who doe. not have any insulance to pay fOl losses and damages. CBIDINERS VISA MIC OTHER I ~~'::::~~e 6\'I7j ~ ~1)~.te.L1ffifu TDATE I TIME I AMour~T AUTHORIZED BY. CREOIT AUTH. NO 641673 MILES DRIVEN '1-r-5\c~~ DRIG"CY\(O \ \ M23\'8;L.cr~n. c.. ( MArv -- \;}., ~ 'ODOMETER 1\ n ':Z H , IN , r/.. ( .J "\ \ ~ETER l\r~'JK'O OAT:7J.. rql:-\ ,. PJr bh" \' \ .~T!.DUE \~ ~-:. '.'~. MAKE.MOOEl.'{EAR.cOlOR LICENSE NUMBER OOOMETER IN ODOMETER OUT \"1 't:; ~ MILES ALLOWED - , CHA.RGEABLE MILES /" It: $ I $ , $ , $ , $ 'rXJ $ ~, ~n Ur~ $ , $ , , , , , , ) 1I':f"> ., r. ' c;.... I"'-o'l'j_ Miles @ Hours @ $ Days @ $ Weeks @ ~ MonlnS I @ ~ri' Total Time and Mileage Charges $ $ $ $ $ , - - $ , , , , , : , $ $ Net Amount Due $ $ - ' $ VI....I '" ,).,(} $ , $ : $ , Net Due Renter WARNING . I have read CarefLJtly all driving and use restrictions on the reverse side. . I am responsible for all traflic violations and mustlurn in all summonses upon return of vehicle, . I will report all accidents immedialely. I have read both sides of this agreement and agree to its terms and conditions. I authorize you to process a credit card voucher, if any, in my name. THIS IS YOUR INVOICE - PAYMENT DUE ON RECEIPT L,,\-f." ,\ ~,. X """"A. "'"C ~ r RENTER'S SlGNATURl! EXTEND TO ADDI1l0NAl.. CASH DEPOSIT S DATE INITIAl.S EXTEND TO ADDITIONAL CASH DEPOSIT S INITIALS DATE C"'S~BY o N BY: r .....VV\ ''''''.'''''1' ADAmSD IIOO,lJ2..,.. FINAL CHARGES ARE SUBJECT TO AUDIT ~~~"""':li,;,-,,"'i~lJriloll~.i:i.dld~~ ,~"~, ~~ ,~~....~ ~,~-, .- '~.. . . RENTAL AGREEMENT ~'\~ . r,1l) . \. "'-- CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717) 691-188Q MILES ALlOWED ~DATliDUE " CHA, RGEABLE :5. ".., no, '!GtO" ,F.".AG.AEEM.ENT MILES " ,-, - _ 'J ",,' . , GAS OUT IN Miles @ " $ I E E 14 14 ADOITI,\~ RENTER NAMEt..... HONE NO, DATE 0...._ 1011 y, 0\\\ C; Jo.\( ....\1" l;dr'-,~" &:- I ~ '4 DRlVER'SLlCENS"~El' , '~.. SA, ~/TlONOA ITli r. ,\ IV f """I Gas (Taxable) A~S PHYSICAl... DAMAGE WAIVER '=is PHYSICAL D~ES 'A etC a, /.:r' ACCEPTS DAMAGE WAIVER X " RATE$\V I'J PERDAV$~PERWEEK x (NOT INSURANCE) By my Imtlals, I accept or decline PhYSical Damage Wawer at the rates listed above Sub-Total ~j $ If] decltne to purchase the WaIver. I accept fU}~S~ns~bjHfY)r loss by colliSion or comprehen- Sales Tax or Surcharge ' $ Slve damage. regardless of cause, up to $ [/!LJ.. (;I /0 per occurrence. whIch may be Gas (Non-Taxable) , / $ charged to my credIt card shown belOw -6 C/CDW (Non-Taxable ...." /i $ AcceptIng reduces my responSibIlity to $ - per occurrence, whIch may be I ) <OJ , , charged to my credIt card shown below. I 71/IzjZ, ~ . "" PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. I d / V I ~1:;' PERSONAL ACCIDENT INSURANCE (PAl) REM""" <I .((. I ............... By my IOIMls. I accept or decline enrollment for Personal Acclderu..~ PERSONAL ACCIDENT $ DECLINES ~:e._~ I accept. I understand and aCknowledge that c~e ACCEPTS INSURANCE .s_al~tes Indicated and that ~have read the cat~ of msurance ~ed by dealer pnor to rental I Sub.Total ~ATE$ D ,. PER WEEK X I PERSONAl... T VERAGE (PEC) A~S ~ By my initials. I t or decline enroll for Personal Effects PERSONAL EFFECTS Cover ae. I cepl, I understand and lC~ow~..that coverage COVERAGE OECLlNe:s is at les indicated and that I h3.\le read tM~te of ACCEPTS t, I nee furnished by dealer prior to ref\lal. --............. I Sub.Total $ ~ RATES PERDAV$ , PERWEEK"- _eSSRef4ndFor: $ VEHIC\Ef!JNDITJON { j)D.",l.-rU SPARE CUSTOMER .. .. $ OUT \ r ~ ..,... , '"" ,.......- .JACK O.K. INITIALS Less Deposits $ / ~ IN . MAl) $ RENTAL WILL BE PR!:J-HY . $ 16J.6 ( RENTE~~_ \=(""". -\h\, r.. f\)D "- \ - HOME\,,~SS,.,.~ ".-.l ,,' A, .l.I1F IL) JCl(") . C In,'")\-.. ,at.. CITYt": -\: (\c.,~--,,_L STA~Jl-_ .~~~ DRI~s~13\c' ST~~C\\' \\~O\ \'ii\"\ M~ SOCIAL SECURITY NO, , HOME PHONE L~:O':ACT ".o~DORESS PHONE ,\ C\Jc.:;-,,-\ e.. ~ fct~ '\\r~~5-S:S ,4--C::;-r E?;'7J A L.~~n ~\o4-5BP~055.;t EYAE?i 8tsA J ..' L ..\\ e. p~ \" h ft,az,. Co..{"o\i C'\'" 0> STtTE l\}ZI'C. Q~l"\"~:> r WIll not under any circumstances surrender the use of the rented vehicle to any person other than Ihose listed below or in Paragraph 6 of the back of this a.greement. Operation of the vehicle by any driver 10 vIolation of Paragraph 6 is prohibited. If none, print NONE across this section. X AENTER.S ~""" DRC REJECrlON OF UNINSURED MOTORIST PROTECrlON AMEX I am rejecting uninsured motorist coverage under this rental or lease agreement# and any poliey of insurance or .el'.insurance issued under this. agreement, for myself and .n other panen- gets of this vehicle. Uninsured coverage pro'teets' me and other passengers in this vehicle for loss and damage. suffered if injury ;s caused by the negligence of . driver who doe. not have any insurance to pay for lo.se. and damages. CBIDINERS VISA M/C Ronte,', ()II f'\ ^ _SignaturUI L.I\Il - I I DATE TIME. OY144l.R , .j I "-MOUNT OTHER Dato ~ IXl qg I A.UTHORIZEO BY CREOIT AUTH NO . ~ "~ '~"" ,- , ': ' ^ ~ ~ --'~""-"? 800-382-1436 "'f 5\o'1C[ , , REPLACEMENT CAR NO. '641852 ORIGO\(Q\ \ MAKE.MOOEL-YEAR.cOLOR . EAR-COLOII ~ "\' t I ..u "'-{") ^rw__\~;a" 17S1~~ OOOJ'~ 'G ~ LICENSE NUMBER ODOMETER IN 'ODOMETER IN ODOMETER OUT MilES DRIVEN .-..-nD ---.J non - DA5;Nj2Im ("~ O~iaL f ~q ~ - Hours @ $ Days @ $ Weeks @ $ Months I @ Total Time and Mileage Charges $ $ $ $ $ $ $ ~ ....,...... , ":I '[ I '( '\ ,~- , , , , , , r-<:'-{ )( e J - 71 ,,~...., 1 $ , -'- - $ ; , $ ^ t__ '--1--. I All ""'I ) Net Amount Due Net Due Renter WARNING . ] have read carefully all driving and use restrictions on the reverse side. . I am responsible for all tfame violations and must tun'. in all summonses upon return of vehicle. . I will report all accidents immediately. I have read both sides of this agreement and agree to its terms and conditions. I authorize you to process a credit card voucher, if any, in my name. ~~SI;~'~~h;;RE~~ ICOO I , I RENTER'S SIGNATURE EXTEND TO ADDITIONAL CASH DEPOSIT S DATE INITIALS EXTEND TO ADDITIONAL CASH DEPOSIT S DATE INITIALS ~MBY r-... \hy'NS~ ,.j annmo:;" ._. J="IN.61 ~HAQ~J=C: .6Pl:' ~"R 1l:'t"T Tf"l .AIII"'IT ~~iIlIl""'H~'H ~~ ~.~~....... ~~ - . RENTAL' AGREEMENT ,~ ( . RENTeR.S INITUlLS IN AE DAC AMEX CBIDINERS \/ISA MIC OTHER ~_c. -'=-'-'~~-""""''I!IiI -"""","""",,,,-,,",,~' '''''....1tJ:0ll\!i0l~ '" - CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717) 691-1880 800-382-1436 , P COllO. '",",,' / I_/~A r I'<UME PHON AEN~J~."L'A~rhn ~ HOME A D~ . f\:l ,/,\ <:!." f'h l ~ /J.r'J-?? CITY / 11 . ^ I. ~~ .17 ' rsr'l'Ej/' r ...... ( i'lJV)/I1 r 1.1 'IX r'J } I'L-- :~SLlCEl<~~'1 4 Ar: i7D~iJ IL}IA SOCIAL SECU"ITY NO, , L'I"AL ~TACT~. A/LX: 1_~I)!'AEr. () /1,....1)....;~0~1 ,,-r TI /I I vr. ,..IPf r/t;(7/()<-{uJ"i I<'{;:-/- "7'-< IV')II n I' /'lI , /<:: rl'HO'5--,.- c- """ LrlV ~ ,_\ ,n(\ "-(I'llI-. V""\'( J'"""'\~) EM l~VEA'S>, DAE"t\ ;::J '/1 I~ r' 6 ,n Y Y fA T~r-, / V. (, rJ t-u I{J '.-, r /'h~rl;m aT "h IV'/1' ~,j ARKV I will not under any circumstilnces surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 of the back of this agre~l!Ient. Operalio~ of the vehicle by ,any driver 10 violation of Paragraph 6 is prohIbited. " none, print NONE across thiS section. if/SID'd55 .642046 REPLACEMENT CAR NO. DA~\'i' b\ \ - EL.YEAR-COLOR 4-l' 1 "'-lm'r 1 r) MAKE-MODEL-YEAR-COLOR UCENSE NUMBER , ODOMETER IN NN.V$~'1 I 7 L.{...,q 1c:...1~ (). 3\10 Dtt-A~'~;..~ ~t.) ~~~7=Htz.v. ODOMETER IN , ODOMETER OUT ODOMETER OUT MILES DRIVEN MIlES ALLOWED '--ni 1\ '> ~~ OUTIN~. HDurs@ S S 1 E Days @ S $ 1 Weeks @ $ ..,$ , Mon\hs \ @ sr,,-, il. ~ ~ Total Time and Mileage Charges $~~'D '00 S , $ , , 1 , 1 1 $ ~!?O ~OO $1 (n' n ::l $ , $ , - .....- R~ECTION OF UNINSURED MOTORIST PROTECTION I am reiectin. unin.ured motorist coyerag. under ,hi. rental or lease agreement~ and any policy of insurance or setf.insurance issued under this agreement, for myaelf and all other passen. gers of this yehicle. Uninsured coverage ptoted.. me and other passengers in this "ehicle for los. and damages .uffered if injut"f is CIIused by the negligence of II drilf8r who doe. not have any. ~i.,urank1ce t. pay f.r I...... j..ncl) damag... R~.t.r" ..... /"\.~ A i I ~ () I St..atu,," ,I I { JY \ 'i IME I AMour~ AUTHORIZED BY E AD~ J llJ ~':' E ~\( 'itirt'E$'V~~; ~Oflf!fi) i ~ DRTiIE'R'S L"'OF' NU E ~ STATElCOONTRY, ~/TEj( '"F ~ ( ~ I Gas (Taxable) ~~s ~YSICAL DAMAGE WAIVER ~ PHYSICAL DECLINES 97 I -5 ACCEPTS DAMAGE WAIVER x RATE $ ,.., . PER DAY $ . ~ PER WEEK x (NOT INSURANCE) By my initials, I accept or decline Physical Damage Waiver at the rates listed above. Sub.Total ~ If I decline to purchase the Waiver, I accept ful' ~s]on:JbiJity for toss by collision or comprehen- Sales Tax or Surchar e Y' .Jt~i sIva damage, regardless of caLIse, up to $ //.//) g /" per occurrence, which may be Gas (Non-Taxable) &'\ nr. charge~ to my credit card sho~n. ?elow. --!.,j@;'C/CDW(NOn-Taxablen Acceptmg reduces my responsibIlity to $ ~- , . per occurrence, which may be charged to my credit card shown belcw.' I ~ ....;( ~ /~ PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. IA< /11') 771.fL ~ PERSONAL ACCIDENT INSURANCE (PAl) I ':r ' '" , ~ ~ my initials. I accept or decline enrollment for Personal Accident V"""" PERSONAL ACCIDENT DEClINES!n . If I ae,capt. I understand and acknowledge that ~9v~ ACCEPTS INSURANCE IS at thel'; mdicated and thai I have~ead the ce: e of insurance furms di!laler prior to rental. Sub-Total RATE $ P Y $ PER WEEK x I PERSONAL EFFE RAGE (PEG) ~~ By my initials, I acee decline enrollme r Personal Effects Covergae. If I ae ,understand and acknowle hat coverage DECl.INES :~s~~~nd!Cated and that I h.,e,read the ~e of ACCEPTS ~. _ _ _ urnished by dealer prior to re"Jal. .............. X ____ RATE $ PER DAY $ , PER WEEK t;c-...... VEHICL, CONJ"f~ON V /. ^ lL.... _ ~. r\ \ s~ CustOMER oUTLLI--I-- KJrcn I )UI II 1 \ , JH /.J.I.~CID,K, INITIALS '- 9--1r 1"'P I I OD~ ~ CREDIT AUTH NO DATE CRE KED 0"," V, C' I '\.::::>..- FINAL CHARGES ARE SUBJECT TO AUDIT "--'1' 1"'1"''''1' ADAmSD ltO:)llll.o'>< $ . PERSONAL EFFECTS COVERAGE 1 $ 1 , 1 , $ : 1 1 $ 1 , , , Sub-Total $; $ I ~r1f.J. (,,'OLJ less Deposits $ I Net Amount Due $ $ Net Due Renter WARNING . I have read carefully all driving and use restrictions on the reverse side. . \ am responsible for a\l traffic violations and ,",ust turn in all summonses upon return of vehicle. . I will report all accidents immediately. I have read both sides of this agreement and agree 10 its terms and conditions. I authorize you to process a credit card voucher, it any. in my name. THIS IS YOUR INVOICE. PAYMENT DUE ON RECEIPT - I'ru \--\..ffi\8:>\ x 5\~' '\. I EXTEND TO RENTER'S' SIGNATURE ADDITiONAL CASH DEPOSIT S DATE INITIALS I EXTEND TO ADDITIONAL CASH DEPOSIT S INITIALS DATE CHECKED IN BY ;;';;;;:;;iO!i;r~~.IIIlOIlli"","J"'~ '~lIirw- u" .. J.L...... "'~ ..,.." '--'~ ,. 'J' _, ~ " =, ~., "Miili&ti:l~~_,-,."""~",, . RENT Al'AGREEMENT CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717) 691-1880 800-382-1436 't.. r E E . Ii v. AD~\\RE~'C'~\PI~ H01jr\~ ~'Ri : ~ DRIVER'S L1C~~E}.NVM~R STATE/COUNTRY EXPIRA~ ~TE r F r F ~/V 1+ I I Gas (Taxable) ~~s PHYSICAL DAMAGE WAIVER ~'S PHYSICAL DECUNES :;l.. ,- -- ACCEPTS DAMAGE WAIVER x RATE $ \ J '~.:L PER DAY $ ~ PER WEEK x (NOT INSURANCE) By my inilials. I accept or decline Physical Damage Waiver at the rates listed above. Sub-Total If I decline to purchase the Waiver, I accept full rrSponS!bility for loss by conlsion or comprehen- Sales Tax or Surcharge sive damage. regardless of cause, up to $ ---l tm (. per occurrence. which may be Gas (Non-Taxablefl_. charged 10 my credit card sho~n. ~erow. --D . C/CDW (Non-Taxable) , U .... -:Accepttn!g~ reduces my responSIbility to $ - per occurrence. whICh may be I arged to my credit card shown below. I. '7..;1. PH L DII.MII.GE WII.IVER IS NOT INSURANCE. rz-. \ \: "f' -.J ~~lli'~s ~EA\S~ONAL ACCIDENT INSURANCE (PAl) TlALS {J-' By initials. f accept or decline enrollment for Personal . nl PcRS_I?_~AL ACCIDENT DECLINES Insuran f I accept, I understand and acknowled coverage ACCEPTS INSURANCE is at the ra ~~e.?Mand t~~rt t~ ~~ certi1icate of insurance furnisti,,~aler pr~"...,. r Sub.Total . ~ATE$ -".,.. $~ERWEEK' . I ~~s PE AL EfFECTS CO E (PEe) . ="'7 By my i . s. I accept or decline enrollment sonal Effects . PERSONAL EFFECTS DECLINES ~o e. If \ ac.cept. I understand and C'lc. knowledge overage ACCEPTS COVERAGE at t e rates Indicated and that I hW8#I"ead the certlYlta&e. of ~ insurance furnished by dealer prior to re'lli..p.L --... .............. Sub-Total $ ~ RATES PER DAY $ PERWEEK x ~~$ VEHIC"ECO~T:ON ,l^. 11 \ -U SPARE CUSTDMER ~$ L~"'''' I'''''''' OUT \,...... +- (~r ' - 8v1't cO JACK D,K, INITIALS Less DepDS"S $ I IN ~ Net Amount Due $: RENfTnAL WliLL B5~ BY Net Due Renter $ I Wfo.RNING . I have read carefully all dri....ing and use restrictions on the reverse side. ORe . I am respoMible IOf all tramc violations and must turn in aU summonses upon REJECTION OF UNINSURED MOrORIST PROTECTION reM" of vehIcle, . I will report aU accidents immediately. I have read both sides of this agreement and agree 10 i1s terms and conditions, I authorize you to process a cfedit card voucher, it any, in my name. RENT.R (~, e. 'r\V"\ ~ C"'c. n \~ \ i .-\ HOMEAlJ{r~, l~ ~ o . CITY r- . \ -,;:; lfATE-,--L.o. ~\ \Ii"'\n 'C.... IV;r_ DRIVE~t+f)S\Z SIVC. BlRTi ii \ )4. -c; SOCIAL SECURiTY NO. lO,,-^,CONTACT. . \~\- ,~DR~ "., '. ,.. ,_, ~~~E,_" h r-.e (""~ "\ e 1\ c:. ( r" "A. '" \n4-h8 I ,-\-'';- 4- E'1PlO,~,.. AJ I . \., r. ~ 1\ PHONE I D,.,L ... , 'L.--b. \~ C. '""" (\I, f1 oc.., ";;(Ji~e;r::o~,L NC 'dEJUrdt5 C'G f0 A - L .,t'I',\:ATE.c, \:;Ur:-~ I R~F~~2;'!J I will not under aoy clrcu;~tancQs surrender the use of the rented vehicle to any GAS person other than those listed below or in Paragraph 6_ of the back of this OUT IN agre!'lmenl. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. It none. print NONE across this section. ^1"'.... \ ~,... ., \lucTreI \ 0\. :tF 4..P:';i IC~ n-,\~\ HOME PHONE AMEX I am rejecting uninsured motori.t coverage under this rental or lease agreement, and any policy of quurance or self-insurance issued under this agreement, lor myself and aU other passen. gen of this vehicle. Unirw.u-ed cover. proteds me and other plssengers in thil vehicle for loss and damage. luffereel if iniury is caused by the negligence of a driver who d.oes not have Iny insunlnce to pay for losses and damages. CB/DINERS VISA M/C Rente,', 5', Cw-.. C', \ ..... I Signature \.J' I Or\. \- I "'Dite TDATE -I TIME , AMOUNT AUTHORIZED BY I OTHER CREDIT AUTH. NO ,642278 ODOMETER IN 516~ 6':r OR"" n rID ) \ "~q~~C\e l ru^rpE~ \ ~ ~ OOO~ETER l s:?,c.. - ,. ~r 114-1<\ \ll~\/) I~AN~~K\C\ ~ '3L~ r"')~ ii5;\'\ \J..., DATe DUE ~ OF AGREEM~ ' REPLACeMENT CAR NO. MAKE-MOOEL~'(EAR-COLOfl LICENSE NUMBER ODOMETER OUT MILES DRIVEN MILES ALLOWED CHARGEABLE MILES b EXPIRA Miles @ Cl: '$ Hours @ $ $ Days@ $ $ Weeks @ $ $ Months\ @ $n~(J-,^ $ Total Time and Mileane Charnes $ $ $ , ! I"r-o , I , I , I \0.1 c:;:;.".,("Y.... 'l.~ $ lKl, I' $ $ $ $ I ....1-. - $ $ $ , , , , , : ~H5,::~~C::~~~E~rLt\50 \ RENTER'S SIGNATURE ADDITIONAL CASH DEPOSIT . EXTEND TO DATE INITIALS EXTEND TO DATE: INlTIAL.5 ADDITIONAL CASH DEPOSIT . C~/W C~KED IN BY ~ 4-.. \....0 ''''''''''''1' ADAmSD ,400'111"'" FINAL CHARGES ARE SUBJECT TO AUDIT "- 7 ~""kIIi;",'-'i",,"",,"'~~" I !IIllllll'''''''''-~" _M b.~ " "_ '.......~ -='\:" -. - ,~...' ~ ~ . RENTAL AGREEMENT , CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike . MECHANICSBURG. PA 17055 N (717) 690-1880 . (800) 382-1436 o. REPLACEMENT CAR NO. .~~~, ~. ~lj__#~"""',:si"",,""_F Ref#: 62 QRlll'l;NO. 01,611 "MAKE,MOOEL-YEAR'COLOR DODGE ,DURAN 99WHI Uc:eNSEI'Il!M8ER NNP127 ODOMETER IN 20848 ODOMETER "', OUT ," t~93? DATE AND TIME IN MAKE-MODEL.YEAR-COLOR LICENSE NUMBER ODOMETER IN ODOMETER OUT MILES DRIVEN EMPLOYER PHONE 9104580552 EMPLOYER'S ADDRESS CITY STATE ZIP . REFERRED BY 7000 ACCT I wjU not under any circumstances surrender the use of the rented vehicle to any per$on other than those listed below or in Paragraph: 6 on the back of this Agreement. Operation of the vehicle by any driver in violation of Paragraph 6 is protlibited. If none. print NONE across this section. GAS OUT IN E 0.20 0.00 @ 49.00 @249.00 l; MONTHS @ 850.00 X TOTAL TIME AND MILEAGE CHARGES fUEL OUT: FULL FUEL IN: FULL 14' Y4 ADDITIONAL RENTERNAJ1!I; , " GLEI:fflIf. ffl'$TER ~,llrj1; l'HOf'j;f'jll; 1> 2240516 ER'S INITIAlS ACCEPTS ,%,:: % F F GAS IT AXABLE) PHYSICAL DAMAGE WAIVER (NOT INSURANCE) SUs. TOTAL SALES TAX ~~RGE GAS (NON. T AXABLE~ . 88 PER 1 8 C/CDW (NON. TAXABLE) RENTER'S INI1'IALS DECLINES X By my initials. I accept or decline Physical Damage Waiver at the rates listed above. If I decline to purchase the Waiver. J accept full r!sponsi,bU_itv for loss by collision. or Physical damage. regaTdless of cause up to $ ,: 10:00/0,-,''"'-' per occurrence, which may be chllrged to my credit card shown below. Accepting reduces my responsibility to $ cMrged to my credit card shown below. PHYSICAL DAMAGE WAIVER IS NOT INSURANCE REJECTION OF UNINSURED MDTORIST PROTECTION I am rejecting uninsured motorist coverage under this rental or lease agreement. and any policy of insurance or self-insurance issued under this agreement, for myself and all other passengers of this vehicle. Uninsured coverage protects me and other passengers in this vehicle for loss and damages suffered if injury is caused by the negligence of a driver who does not have any insurance to pay for losses and damages. PHYSICAL DAMAGE WAIVER RATE $ PER DAY $ PER WEEK per occurrence, which may be $ '" $ $ $ 0.00 0,00 850,00 $ 0':00 850;00 $ 25,50 3.00 '" 2.00' DAY PTAF TAX PERSONAL ACCIDENT INSURANCE $ SUB-TOTAL $ 926,50 PERSONAL EFFECTS COVERAGE $ Renter's Signature ~. "" Dale I SUB-TOTAL LESS REFUND FOR: VEHICLE CONDITION OUT .PARE JACKO.K. CUSTOMER INITIALS T alai Charge I:: LESS DEPOSITS $ 926_50 IN LR BUMPER DAMAGE RENT l Will B PAID BY GNA NET AMOUNT DUE $ $ $ $ 92 .: 0 926;.50 DRC NET DUE RENTER $ WARNING I have read carefully all driving and use restric:tions on the reverse side. I am responsible for all ~rattlc vio\a~ions and must ~um in all summonses upon return of vehicle. I will report all accidents immediately. AMEX RO#: I hIIve read both sides of this agreement and agree to its terms and conditions. I authorize yOU to process a credit card voucher, if any, in my name. THIS IS YOUR INVOICE - PAYMENT DUE ON RECEIPT CB/DINERS VISA x RENUR'::i 51liNATUAE EXTENDED TO AODITI NAL CASH DEPOSIT DATE $ EXTENDED TO ADDITIONAl CASH DEPOSIT $ CHECKED OUT BY: JACKIE M/C OTHER. CREDI AUTH. NO. AUTHORlZ D BY: FINAL CHARGES ARE SUBJECT TO AUDIT INI IALS INITIALS ~:;:';~i&2"'I" ~o. __ ~~" - - -",,- '_~.._"'.~~ ~__M _ .. "~~, ~_,," " IlllI - ~ ~ 1"""'~-".,,-1\ili411!.;I~;'!U,- . ~'''S'f>j;-''L,'.",",~=e""., CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike . MECHANICSBURG, PA 17055 N (717) 690-1880 . (800) 382-1436 o. REPlACEMENT CAR NO, RENTAL AGREEMENT Ref#: 96 .Q~I~..,.pII\..~O.. Pi61t ',.,. ., ~!(E'MOI:1E\;~,,~Myc;QLOR jjODGE .jriUiiiN . :.9:9:' :.WHI 1;tq;:~~I'!l!I!ll!~R ~Pt;n ODOMETER IN MAKE-MODEL-YEAR-CDLOR LICENSE NUMBER ODOMETER IN ODOMETER OUT MILES DRIVEN '<:MILES ....,'" .!\LLPWED 22546 ODOMETEFI OUT DATE AND TIME IN EMPLOYER PHONE 9104580552 EMPlOYER'S ADDRESS CITY STATE ZIP REFERRED BY 7000 ACCT I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 on the back of this Agreement. Operation of the vehicle by any driver in violation of Paragraph 6 Is prohibited. If none, print NONE across this section. 0.20 0_00 @ 49.00 @ 249.00 MONTHS @ 850.00 X TOTAL TIME AND MILEAGE CHARGES FUEL OUT: FULL 0,00 0)00 850JOO $ $ $ $ $ $ AC!D,IT!ON~.~.~NT~~.N&Mf.".::.:. i::............,. .(;r.'E:~<f;...l>1El'l~E:R..:....... GAS (TAXABLE) PHYSICAL !>AMAGE WAIVER (NOT INSURANCE) SUB.TOTAL $ SALESTAXO~RGE % $ GAS (NON. T AXABLEl; . 88 PER 1 8 $ C/CDW (NON-TAXABLE) $ oJoo $ RATE $ PER DAY $ PER WE~K By my initials, I accept or decline Physical Damage Waiver at the rates listed above. If I decline to purchase the Waiver, I accept fullres..Pons.ibility for loss by collision. or Physical damage, regardless of cause up to $ ,:,: :1,00.%' ,;,':', per occurrence, which may be charged to my credit card shown below. Accepting reduces my responsibility to $': per occurrence, which may be charged to my credit card shown below. PHYSICAL DAMAGE WAIVER IS NOT INSURANCE REJECTION OF UNINSURED MOTORIST PROTECTION I am rejecting uninsured motorist coverage under this rental or lease agreement, and any policy of insurance or self-insurance issued under this agreement, for myself and all other passengers of this vehicle. Uninsured coverage protects me and other passengers in this vehicle for loss and damages suffered if injury is caused by the negligence of a driver who does not have any insurance to pay for losses and damages. 850~00 3.00 % 2.00' DAY PTAF TAX PERSONAL ACCIDENT INSURANCE 25.50 '$ $ SUB-TOTAL 926J50 $ PERSONAL EFFECTS COVERAGE $ Renter's Signature VEHICLE CONDITION OUT ~, ,. Oe,t" I SUB- TO AL LESS REFUND FOR: $ $ $ $ 92 .50 SPARE JACK O.K. CUSTOMER INITIALS Total Charge I'" 926':50 lESS DEPOSITS IN LR BUMPER DAMAGE RENTAL WILL E,PAlD BY G~A NET AMOUNT DUE 926.50 $ NET DUE RENTER $ WARNING I Nve read carefully all driving and use restrictions on the reverse side. I am responsible for all traffic violations and must turn in all summons. upon return of vehicle. I will report all accidents immediately. DR AMEX RO#: I have read both sides of this agreement and agrH to its terms and conditions. t authorize you to process a credit card voucher, if any, in my name. THIS IS YOUR INVOICE - PAYMENT DUE ON RECEIPT CB/DINEAS VISA x RENTER'S SUiNATURE EXTENDED TO ADDITIONAL CASH DEPOSIT DATE $ EXTENDED TO ADDITIONAL CASH DEPOSIT DATE $ CHECKED OUT BY: CHECKED IN BY: JACKIE JACKIE MIC INITIALS OTHER INITIALS CREDIT AUTH. NO. AUTHORIZED BY: FINAL CHARGES ARE SUBJECT TO AUDIT CUMBERLAND VALLEY MOTORS ~\iP\~ 6720 Carlisle Pike' MECHANICSBURG, PA 17055 N Ref#' 192 (7171690.1880 . (8001382.1436 O.~. ,~;.. ; II ii REPlACEMENT CAR NO. OWl;, '.' .,010; .,...))1611 .."."" . i ,.....,.. MAKE'MODEL-YEAR.CDLOR~I~l?'~~;~J',I\~c OODGE.DURAN9 ,'.'.. _. LICENSE NUMBERllg;NSENUMllER 0' ,..'..,...."" ,..,. NNP127 . ;)< ,i ODD~ETER ODO:t,ETER '2 L\ b1 te ... ~., 0 OO~~TER O~~~ERI22!i-4fii PHONE MILES D~E AND TIME ~'}-y.,. DRIVEN 2\50 '-.l. I~ ""'t-1 ~:~: A~~~~ I. 3bgg ..~~ia )~j/i;~~0~~3~'0~:~: CHARGEABLE A:..~~!~!~~g~"fi~€p^ MILES \..l-.J Ipjt.?~.JrrJ~ ~""j;-^~-.'~. =- lib.. ~~, ~~ ~-,",- -~ =~_O~ ~.~._ RENTAL AGREEMENT. ! ~- ~.) , 1:1 .'.'"....."...'., '.~ ~., LOCAl. CONTACT ADDRESS EMPlOYER PHONE 9104580552 EMPLOYER'S ADDRESS CITY ZIP _ 1REFERRED BY I 7000 ACCT STATE I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below Of in Paragraph 6 on the back of this Agreement. Operation of the whicle by any driver in violation of Paragraph 6 is prohibited. If none, print NONE across this seetion. GAS OUT IN '~ E FUEL OU:1': FULL % % tDiD.I,GT.I...r.....Et..L...,.......,...R...,..,..E...F'.J......"f....E.E.,......,..lf,.....,...~.~AS.~.'..E'.Ri..........'......'~.'....'...'.,...'..... ,c~ ,!>A"f~p"c~!lf1'li ,., y, , .,. . ....m... ""... ~..{Wii"25;:"" ",11'Jl1fll. %. % " .", .,..~. ,...,.".... .t;'.... ""'2.240516; .','..,,1'1,[3' ..,'.."..JiljjyBf" 'F F I;\~~r RATE $ lP;~;;ALp:::::E$WAI;;.65 PER WEEK *~~~s By tnv Initials, I accept or decline Physical Damage Waiver at the rates listed above. If I decline to purchase the Waiver. I accept full resjtonslbilitV fOl loss by collision or Physical damage, regardless of cause up to $ _ :, ..lOO% -:..:', per occurtenc::e. which may be charged to my credit card shown below. Accepting reduces my responsibility to $ charged to my credit card shown below. PHYSICAL DAMAGE WAIVER IS NOT INSURANCE REJECTION OF UNINSURED MOTORIST PROTECTION I am rejecting uninsured motorist coverage under this rental or lease agreement. and any policy of insurance or self-insurance issued under this agreement. for myself and all other passengers of this vehicle. Uninsured coverage protects me and other passengers in this vehicle for loss and damages suffered if injury is caused by the negligence of a driver who does not have any insurance to pay for losses and damages. per occurrence, which may be Renter's Signature ~, -I Dale I VEHIC~E~9NDITI0.N-: - ,... '..,---c-- C3.- ...,.. ..,' ,.,.,.','.,. ..' OUTLRBOMI>ER DAMAGE ..','.'..,...', ..... ,',. ,'....,.. ....,' SPARE JACKO,\(.. CUSTOMER INrTlA1.S IN l'\ENTAL WILLBE ~AIDBV . ..',.,. GNA ., .'...'. . ,....',. ,"ii ...," '.',., ., " '......,..'.,.,. erne AMEX CB/DINERS RO#: ISA liMe OTHER BlED IT AUTH. NO, TIME TAMOUNT AUTHORIZED BV, I DATE L .~ ~~~-,......","-,-.~ ililil.mll'.II . ',~""" \ \ , MILES @ 0.20 HOURS @ 0.00 DAYS @ 49.00 WEEKS @ 249.00 MONTHS\@ 850.00 TOTAL TIME AND MILEAGE CHARGES $ $ $ $ $ $ $ $ ~ GAS (TAXABLE) PHYSICAL DAMAGE WAIVfR {NOT INSURANCE) SUB-TOTAL $ SALES TAX Oll~RGE ~ nn % $ GAS {NON-TAXABLE) h. 8 A P"R 1 18 $ C/CDW {NON- T AXABLEI $ $ if'V'"\ .........,.; .! ~^ $ 2.00% 2 ~ 00 I DAY PTAF TAX PERSONAL ACCIDENT INSURANCE $ SUB. TOTAL $ . PERSONAL EFFECTS COVERAGE $ . SUB.TOTAL $ ~$ _$ LESS DEPOSITS $ u.... -V ~ ~ NET AMOUNT DUE $ . , NET DUE RENTER $ WARNING I Mll. tead careflollly an driving and un rlfll5uictiol15 an the rlflVlfltS8 sic:kl. I am respansibla far all traffic violations and m\.ll5t turn in all summal'lHS upan return of vehicle. I will report all accidents immediately. I helle 'ead both sides of this agreement end agree to its terms and conditions. I authorize you to proeess a credit card voucher. if any. In my nama. TH~.~S YO~R INVOICE -,:AYME T DUiE;XEC~L.\. \ ~ E lURE EXTEND~ ADDITIONAL CASH DEPOSIT DATE INITIALS $ EXTENDED TO ADDITIONAL CASH DEPOSIT DATE INITIALS . CHECKED OUT BY: JACKIE 1 CHECKED IN BY: FINAL CHARGES ARE SUBJECT TO AUDIT $II1!1w.d~i1IiiIrulWiilI'~""" '" ~ .' RENfAL AGREEMENT ~~ ~ "= CUMBER,LAND V ALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG, PA 17055 (717) 691-1880 800-382-1436 ORIG.~ NO, . . I~II All ~ "',. ~n N"' LICENBl! N~I/BEI< ...;;..' ' < ,\..\... '\ \..;I,~ 1 OOO:1.ETER OJ'3 ?:ll. ~r,2t..t~;I_ ?( ;,(.1) L- OA\(5/~l'Ao. e: AL~ ' \ ~ ~ D~:>lD~:: ~~ ~HARGEABLE ~Cf"'\ """,J!'" MILES ," . , , ___'" ,," _, ,', >_ AM~ . . GAS OUT IN Miles @ . '~'"$" , HOLlrs@ $ $ I Days') @ $\:.lrvr. $ ~ Weeks@ ~. $ Months ~ , $<;;' :,r.. f Total Time and Mileage Charges $ $ $ E E '4 "" rr\::::RN~~'t:"MEPHONENO. TviJi~",:: ORIV",,'5 UCENSE NUI/BER STATE/COUNTRY EXPtI'~~" .~TE F F ~'\__\' A "-::lr II I I/^ / Gas (Taxable) '. PHYSICAL DAMAGE WAIVER ~ PHYSICAL CLI ES r\S 01' .~ ACCEPTS DAMAGE WAIVER x RATE $ _\~~ PER DAY $ U~PER WEEK X (NOT INSURANCE) ~y initia"rn7'1 accept or decline Physical Damage Waiver at the rates listed above. Sub-Total If I decline to purChase the Waiver, I accept full responsibility tor loss by collision or comprehen. Sales Tax or Surcharge ut.. D'J si~e damage, regardtess of cause, up to $ \nO~ per occurrence, which may be- Gas (Non-Ta)';able) ~.::=...o r__ I charged to my credit card shown below. G C/CDW (N .T bl) Accepting reduces my responsibility to $ per occurrence, whIch may be on axa e charged to my credit card shown below. - . I ~ PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. 1,..1... , , OT f.J.r:= +t>.Jt ~=ss PERSONAL ACCIDENT INSURANCE (PAl) ~ -:-J. . --......... By my Initials. I accept or declme enrollment for Personal Accident ~ PERSONAL ACCIDENT OECUNE~ Insurance If I accept, I understand and ackl10wledge that co A.~eCEPDft; INSURANCE -- ~t tM rates Indicated and that I have read tne ~te of ,-...,.... ~ inS ce furnished by dealer prior to rental. ~ I Sub-- Total ~ATE $ PER DAY'~ PER WEEK X I PERSONA S COVliRAGE (PEC) ~. By my initials, I . pt or decline en t tor Personal Effects PERSONAL E.FFECTS Cover ae. cept. I understand and ackno verage COVERAGE OECL.lNES is at I ates indicated and that I have read ine certhlc ~PTS j nee furnished by dealer prior to rental. --.......... SUb--Totat $ X ~ RATE$ PEA DAY $ PERWEEK X ~$ ~~~L~CO~'t~ e()r\ '" ~, ,N>.N \~ r;::;':;:r. ~USTOM R ~: ,- --- Net Amount Due $ Net Due Renter $ WARNING . I have read carefully all driving and use restriclions on the reverse side. . I am responsible tor aU traffic violations and must llJl'n in all summonses upon return of vehicle. . I will report all accidenl$ immediately. I have read both sides of this agreement and agree 10 its terms and conditions. I authorize you to process a credit card voucner, if any, in my name. RENTER (P7::l N A HOME ADDRESS , \C?_Q 1\.\ I /"I v" p""...~ ....,... CITY STATE ('\ r\ .,. ^ \ f"'<7 .f-' - "I1r. DRIVER , ~, STATE Elll'. DAle '. ~~1.. H.."'-.\C,.:. . 11-1\-(\1 aT'RT ,H O~TE ~. , SOCIAL SECURITY NO, ....:, HOME PHONE IlJ~~ U/-;'-~ LOCAL C~T......r- '"1 A) l"S't';r. PHONE EMPLOYER J PHONE , , . 1.., r :l9.uz.9- EMPLOYER'S ADDRESS CITY I REFERRED BY I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 of the back of this agre~~nt. Operatiorl of the vehicle by .any driver In vio\ation of Paragraph 6 is prohIbited. tf none, print NONE across thiS section. STATE ZIP X RENTEln '"'''''. IN RENTALW~L aE PAIDi D Q 5 ORC REJECTION OF UNINSURED MOTORIST PROrECTION AMEX I am reieding urtinsured motorist coverage under this rental or I.... .greement~ and any policy of insuranw or lelf-inluranw issued und.r this agreement_ for myself and .11 Mhor passen.. Ger. of fhi. vehicle. Uninsured coverage protectl me and other passengers in this vehicle for lOll and damages suffered if iniury is caused by the negligence of. . drift' who doe. not have any insurance to pay for lossel and damages. CB/DINERS VISA MIC ~~~C'--j/67') rY't,.tO,D ~ OTHER "'OC,",IT AI,TW ",-, REPLACEMENT CAR NO. MAKE.MODEL.YE:AR-COLQR UCENSE NUMBER ODOMETER IN OOOMETEJ:\ OUT MILES DRIVEN r"' r~ !~&l;tll~ril.;.;] 642826 \.,/ " $ $ $ $ $ " ~ a 1- \1" \' 1 LiO, $ , , , , , , , , 7[Y"o, , $ $ , , , , , , OQ fH1$1S YOUR INVOICE. PAYMENT DUE ON RECEIPT "RV'..r\ ~1^U \;:.~>} \' . X - - r f\ENTeR SIGNA: EXTEND TO "" ADDITIONAL CASH DEpOSIT . EXTeND TO AODITIONAL CASH DEPOSIT . DATE INITIALS DATE INITIALS .~~Ib~,Ll;,'jiti~",,""';'lk~7-~~'-'- . ~ ~ . <'~ -~ . RENTAL AGREEMENT ~~~ ~- ~"~-~"".. . .""'~~- llii!l!illllilll~"""'''''M' :ilr'~'~~' CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG, PA 17055 (717),691-1880 800-382-1436 ~ "'- ~iP;'~~ ~ATSDUE ,~ CHARGEI\BLE :no F AG MILES - AM , .' ,,,';" . " GAS OUT IN Miles @ Oe$" . Hours@ $ $ 1 Days@ $ $ , Weeks@ $ $ I Months \ @ .I"Y". $ ""'1'""- ~Ioo)(.I'J Total Time and Mileage Charges $ Ci;..J.. "'"'1r' r--.., $ , $ , , , , , , $ -. ()Io.. J :<..0 $ ~\.....' Jt:; $ , $ , ~ - E E ~ v. A~\t RrJ; N~\ \~ - .~E l1 ~'l \ DA!J.;""'i ~:. DRIVER'S L1CENSE~BER r I \ STATE/COUNTAY EXPlAA;JIONDA ITS . F" ('1- IT" 1\ I Gas (Taxable) ~s PHY ICAL DAMAGE WAIVER ~ PHYSICAL DE N "'- ~ .- ACCEPTS DAMAGE WAIVER X X. RATE $ , ...> "\::;1 PER DAY $ q, 1- (Q? PER WEEK X (NOT INSURANCE) By rrf, initials. I accept or decline Physical Damage Waiver at the rates listed above. Sub-Total If I d~cline to purchase the Wai....er. I a.ccept full respons!bility 10r loss by collision or comprehen- Sales Tax or Surcharge ., A ,. sive damage. regar~less of cause, up to $ I Iml per occurrence, which may be Gas (Non.Taxable)~ .h/l, I Fl.. 1 ~ charge~ to my credIt card sho~n. ~eIOw. ~ . C/CDW (Non-Taxable) , 0 Accepting reduces my responslbllJty to $ -c.. 'J - per occurrence, whIch may be I charged 10 my credit card shown below. I I I . ;;.c J, PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. I.~ .Il [) nil / N nrTJ.I\ ~n rr ~~n~ , PERSONAL ACCIDENT INSURANCE (PAl) ~ ,l'J r U ~nitlalS, I accept or decline enrollment for Personal AccideJ],t. ~ PERSONAL ACCIDENT DECLINES !nsuran. ac:ce . t, I understand and acknOWledge that c~e ACCEPTS INSURANCE IS at the rale aled and that I have read the~cate of insurance furnished ~er prior to rental. .-. I Sub-Total x RATE $ PER PER WEEK X _ I R~S ~PERSON CTS COVEAA Ee) 'lk~i' ~ By my mlllal ccept or decline enrollment for Pe I Effects PERSONAL EFFECTS DECLINES Cover accept, I understand and ~krlQwledge that l?_~~ COVERAGE IS e rates Indicated and that I h<fie"'tead tf\e ceftlflCate lJto ~EPTS t -""'" urance furnished by dealer pnor to rerifal I --.......... I Sub-Total $ x-" RATE $ PER DAY $ PERWEEK x ~$ VEHICLECONDITI~ SPARE CUSTOMER _$ II OUT ~ " ~ JACK O.K. INITIALS Less Deposits $ ...._,,~- IN <. .~((~ RENTAL WILL BE PAID BY 1626 RENTlI''lPRI~'- A I A '\ 1-1(',.\,,;)\6 ,~.l.. ,\" _.. ;..~e. HOMU 'J1~ fo\e6~ Lc,'f'\e *a\\,\ CITY D~\ \~ ST~^ l5~tt DR",EYDE~E~OI'lf)t.+ STT1.. . \~.~~D~ ,"f1')0~1:::"'.t:: Q. SOCIAL SECURITY NO, HOME PHONE . . r-1~ONTn AOD~S~ '+5A ~P~N5~ E~ J 4 q \0 ~\.!SO(-l'" 1.'7 E\BJSC~DR1\). ~\\e- ~\\~ f\~. F. -\\~ ~T;),..... "Jue. I rAt. D,B{f'lp I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 of the back of this agre~l'!lent Operation. of the vehicle by any d~ivef In violation of Paragraph 6 is prohibited. If none. pnnl NONE across this sectIon. DRC REJECTION OF UNINSURED MOTORIST PROTECTION AMEX I am rejecting uninlured motori.t coverage under this rental or lea. agreement, end any polky of insurance or self-insurance issued under this agreement, for mv.elf and .11 other pIls.en- gers -of tM. veh.icle. Unin5llred coyerap proteds me and other passengers in this vehicle for loss and damage. suffered if injury is caused by the negUgenc8 of . driver who do.. not . have any insurance to pay for loues and damage., X CB/DINERS VISA Mle '~\~Jlot.~ lePfl OTHER R~nt.r'. ~.. r \ - Signature n \ V\ ~ CREDIT AUTH 'NO I DATE AUTHORIZED BY TIME I AMQUln 642123 REPLACEMENT CAR NO. OFlIG,~_NO. ,ro. C l.J\ \ \.J qEq'El' ~<XlPt\65 "~\'.:\Q~I ODO:1.ETER , C; '1 'd. ,"A ODOMETER I\~I) OUT \ "" _ O:r"/~I~{,\ ~~ MAKE-MODEL-YEAA.COLOR LICENSE NUMBER ODOMETER IN ODOMETER OUT MILES DRIVEN ~ ,Iy- Jr,.).. $ $ , , , , , , , , , , , , , - $ $ '7 lTl, i-I.'l Net Amount Due $ $ Net Due Renter WARNING . I have read carefully all driving and use reslriclions on the reverse side. . I -am responsible for a\l trame violatiOns and must turn in all summonses upon return of vehicle. . I will report all ~cidents immediately. I have read both sides of this agreement and agree to its terms and conditions. I authorize vou to process a credit cafd 'IOucher. if any. in my name. THIS IS YOUR INVOICE. PAYMENT DUE ON RECElpr '--- ~ G4-\~ca. RENTER'S SIGNATURE ADDITIONAL CASH DEPOSIT . -' '-J EXTEND TO DATE INITIALS EXTEND TO ADDITIONAL CASH DEPOSIT . DATE INITIAL.S CHEC..KED OUT BY: ~I"\ CHECKED IN BY .e.O/5,m5" .~ . ~INI1I ,......,IiQr:~~ {lOc: (,'110 1l="'T""'1"\ AI......'.... """-~-:,-,",-~~,~"",,ji!!iUi' ",~", ~ -. ..">~- """'=-~~~"""'-< -,"' ~'"'-- ~=~~.._- ., CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG PA 17055 E E 14 14 ~AL7S:'\\~'\eJ) r\i~~ OATEjalRi : ~ DRIVER'S LICENSE N~ER r. \ ':ATEICOUNTRY EXPtRA~ ~TE I~ ~ ~ \J""J\J. T / / - Gas (Taxable) ~: PHYSICAL DAMAGE WAIVER ~ PHYSICAL X~ RATE $ \ 0:\ S PER DAY $ ~ PER WEEK X ACCEPTS ~'6~~~~U~~~~) By-~ y initials, I accept or decline Physical Damage Waiver at the rates listed above. Sub.- Total ~ If j J cline to purchase the Waiver. I accept full responsibility for loss by collision or comprehen. Sales Tax or Surcharge sive damage. regardless of cause. up to $ '00% per occurrence, which may be Gas (Non.Taxable)a.~ . a' charged to my credit card shown below. C _ CtCDW (Non-Taxable) Accepting reduces my responsibility to $ - '7 per occurrence, which may be r charged to my credit card shown below. I PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. ,~ .".) 1 r.... oV, t:.. ... " PERSONAL ACCIDENT INSURANCE (PAl) J. ,-,,, ;nitials, I accept or decline enrollment for Personal PERSONAL ACCIDENT OECUNES Insuran. cent, t understand and acknowledn.. _ ~overage ""..,."".T8 INSURANCE IS at the rates r. and that ,I' hav~ e certificate of """""'"' insurance furnished by r[or t~r. RATE $ ~DAY $ --- PER WEEK X . PE Al EFFECTS COVERAGE (~ ~ By my I S. I accept or decline enrollment forPer~on~ls DECLINES ~ ,~t~:C,~~~:.\."J'clJ~~~g~, ar~t~i':ijdl~~ t~::.~?;:.~a.';f ~ I ./ rnsurance furnrshed by dealer pflor 10 ref}tal Iv/" RATE $ PER DAY $ . PER WEEK X I VEHICAE",CONDR. _ SPARE CUSTOMER ouTI \ h '-.. , " .r JACK O.K. INITIALS IN <;:;e:- Y"\ e- RENTAL WIll BE PAID----m -, OJ S (717.) 691-1660 RENTAL AGREEMENT . RENT JVPRIN,\ 1\ \ 1- \ ' ' ~('1'(.)\O rrr 'VI . A~~-te. HOM ~6-q Fo~ ~ ~.1:k ~ \\ '\ CrN " ," ~ stA';. '/...' ..., ~ ZJ~~- ORI" '0' ~,,!:JRrI4- stT' 'f. . \2 ~~ ~T~ om- 8 "socIAL SECURfl'Y NO. HOME PHONE \,..,l lJt;16l. . r;~~T E~N ~ "\ \ 0~\ -o~ 15" EM{'C;J..t;RYS ~ \ ~e.. ~(\~ A- u:.... T..l'A(tJ\\'N. ~_;~ If Ie -~R~,\D"'f8 q~DREt?6 -enS ::ONE I will nol under any circumstances surrender the use of the renled vehicle to any person other than those listed below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. If none, print NONE across this section. GAS OUT IN X ReNTER.!!. INlTlALS ORC REJECTION Of UNINSURED MOTORIST PROTECTION . AMEX I am raiecting uninsured motorist ewer'ge under this rental or lease agreement, and anV' policy- Df insurance Dr self.insurance issued under this agreement, for myH1f and ell other PBSle-o. gerl Df this vehicle. Uninluntd coverege proteds me and CJth.r paJ,'~ft9"'$ ift this ..,ehk:\e for loas end damages suffered if injury i' clu,ad 'by tbl nlgliglncl of I drivo, who dOl, nol have any insurance to pay for Ioues end damage.. C6/0lNERS VISA MIC OTHER Rente,'s . ~ \ Sign.,ure6~ lIe. TDATE TTlME I AMOUf~T AUTHORIZED BY Dete ..3 , '0 fh. CREDIT AUTH NO ~ \L...<'~~ )ll~ 6 42390 ORIG _ (') \ '\'\' ~t\'\Y ~ J &-, L~V": \~ld. 1 OOO~ETER I () 2L/ OOCS"~ ct;=;:I;;(6 o(Q'i TJU iq,,- ~~/soA'\ DATE DUE EXPIRATION OF A , , , I ~ , Sub-Total $' ~$ !^( ~$ \(~'n.J Less Deposits $ r : , 600.362-1436 REPLACEMENT CAR NO. MAKE.MODEL-YEAR.COLOR LICENSE NUMBER OOOMETER IN OOOMETER OUT MilES DRIVEN \ P-0 \ ~' MILES ALlOWEll CHARGEABLE MilES Miles @ HoulS @ $ Days @ $ Weeks @ $ Monlhs \ @ ~ Tota' Time and Mileage Cha,ges I Sub.Total I PERSONAL EFFECTS COVERAGE Nel Amount Due . , '"'"""~~ -~ '.. "'-'lliI&I""'''~,"''' ~ E c $ I $ t $ t $ - , $~ ) $ 7).--r $ I $ , I , $ I , $ '-\~ "'" -eX) $ "1-1 .~ $ ....t~....... $ , , , , , $ , , , $ , , f~ $ $ $ Net Due Remer WARNING . I have read carelully all driving and use restrictions on the reverse side. . J am responsible for all traffic violations and must turn in all summonses upon reluro ot vehicle. . I will report all accidenls immediately. I have read both sides of this agreement and agree to its terms and conditions. I authorize you to process a credit card voucher, if any. in my name. THIS IS YOUR INVOICE- PAYMENT DUE ON RECEIPT I x5,a ....J EXTEND TO ~ G'-\-l3<<1~ RENTER'S SIGNATURE ADDITIONAL CASH nEPOSIT S DATE INITIALS EXTEND TO ADDITIONAL CASH DEPOSIT . CK 0 OUT BY; "'\/'\ ADAmsu F=INA' r"HAR(,::;t:'C APt:' C::"Q rt:'r""T TI'\ ""nIT DATE INITIALS I~rr ,_>w.",~~~= M.~ <>~ . "'__W_ ~. "=IiIIiilli..< --.......~!iJii_lIiliimH iiJ 1:~ ,"g,I"",~J!t;'~ RENTAL AGREEMENT' CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike . MECHANICSBURG. PA 17055 N (717) 690-1880 . (800) 382-1436 O. REPlACEMENT CAR NO, E OOOMETER IN ODOMETER OUT MilES DRIVEN MILES ALLOWED Ref#: 67 ORIG.qAltNO; j)lQQ$ MA~E'MODEbYEAR'COLOR DbDGE1W.!W99' GRE Ll!)ENS1;NlI~~ . BCP1227 ODOMETER IN 9392 ODOMETER OUT 7024 DATE AND TIME IN MAKE-MODEL- YEAR-COLOR LICENSE NUMBER PHONE SAM EMPLOYER GNA EMPLOYER'S ADDRESS 1029 N. LAKE PARK A CITY STATE CAROLINA BEAC NC 28428 2368 PHONE 910-458-0522 2368 ZIP - REFERRED BY 7000 ACCT CHARGEABLE MILES o I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 on the back of this Agre"ment. Operation of the vehicle by any driver in violation of Paragraph 6 is prohibited. If none, print NONE across this section. GAS OUT IN 0.20 0.00 @ 54.00 @289.00 1> MONTHS @ 925.00 X 0/. TOTAL TIME AND MILEAGE CHARGES Yo 0000 0;00 925;00 FUEL OUT: FULL FUEL IN: FULL ADDI.,..iONf'L~~"H~~W\~..,........... .'.,.......... .,9ME.~9~.""9.. .;LLQI1!\P:rF,:rj>DDRIY. I NONE F GAS IT AXABLE) RfNTf:R'S . INfTtALS DECL NES X By my initials, I accept or decline Physical Damage Waiver at the rateS listed above. If I decline to purchase the Waiver, I accept full res.ponsliJ,i1itv for loss by coUision or Physical damage. regardless of cause up to $ ',..'.'.'..10U%--:',..':-:,:, per occurrence, which may be charged to my credit card shown below. Accepting reduces my responsibility to $. charged to my credit card shown below. PHYSICAL DAMAGE WAIVER IS NOT INSURANCE REJECTION OF UNINSURED MOTORIST PROTECTION 1 am rejecting uninsured motorist coverage under this rental or lease agreement, and any policy of insurance or self-insurance issued under this agreement, for myself and all other passengers of this vehicle. Uninsured coverage protects me and other passengers in this vehicle for loss and damages suffered if injury is caused by the negligence of a driver who does not have any insurance to pay for losses and damages. PHYSICAL DA.MAGE WAIVER (NOT INSURANCE) SUB- TOTAL SALES TAX ~RGE GAS (NON- T AXABLftJ . 95 PER 1 8 C/CDW (NON-TAXABLE) $ 0;00 RATE $ PER DAY $ PER WEE~ per occurrence, which may be $ % $ $ $ 92 5,00 $ 3.00 % 2.00' DAY PTAF TAX PERSONAL ACCIDENT INSURANCE 27,75 $ SPARE CUSTOMER JACK O.K. INtTlALS , SUB.TOTAL LESS REFUND FOR: $ 1008,25 $ $ 1008;25 $ $ 1008.,25 $ $ 1008.'25 SUB-TOTAL Renter's Signature VEHICLE CONDITION OUT ~, " Oat'(, I PERSONAL EFFECTS COVERAGE Total Charge i~ IN NO DAMAGE RENTAL WILL PAI,D BY GNA LESS DEPOSITS NET AMOUNT DUE NET DUE RENTER $ WARNING I tvIve read carefullv all driving and USfI restrictions on the reverse sidll. lam responsible for ell traffic violations end must turn in ell sUrylmonses upon return of vehicle. I will r8j)Ortall accidents immadillot-'v. DRC AMEX CB/DIN RS RO#: I heve read both sides or this IIrpeement and agree to its terms and conditions:, I authorize you to process II credit eard voucher, if anv, in my neme. THIS IS YOUR INVOICE - PAYMENT DUE ON RECEIPT VISA X M/C XTENDEP T RENnR'"55IGNATURE ADDITI NAL CASH DEPOSIT DATE INITIAL OTHER $ EXTENDED TO ADDITI NAl CASH DEPOSIT DATE $ INITIALS CREDIT AUTH. NO. AUTHORIZED BY: CHECKED OUT BY: JACKIE CHECKED IN BY: DIANE FINAL CHARGES ARE SUBJECT TO AUDIT NET DUE RENTER $ WARNING I have read carefully all driving and use restrictions on ttw reverse side. I am responsible for all traffic violations and must turn in all summonses upon return of vehicle. I will report all accidents immlldiatllly. --"-_.,~~-".... ~~~--. - illII'iIii; ~, ~.~ ...__._~. "'.............. .. ~ ~J RENTAL ~GREr;:MENT' CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike . MECHANICSBURG. PA 17055 N (717) 690-1880 . (800) 3B2-1436 o. REPlACEMENT CAR NO. MAKE-MOOEL-YEAR-COLOR LICENSE NUMBER EMPlOYER ODOMETER IN OOOMETER OUT MILES DRIVEN .,)MllES..,........... !\lI.OWEQ EMPlOYER'S ADDRESS PHONE 9104580552 CITY CHARGEABLE MilES STATE ZIP REFERRED BY 7000 ACCT I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 on the back of this Agreement. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. If none, print NONE across this section. GAS OUT IN 0.20 0.00 @ 54.00 @ 289.00 J\ MONTHS @ 925.00 X % TOTAL TIME AND MIlEAGE CHARGES FUEL OUT: FULL FUEL IN: FULL AO[J~t*I(~i~I~1~~............i RATE $ F GAS IT AXABlE) PHYSICAL DAMAGE WAIVER INOT INSURANCE) SUB-TOTAL SALES TAX ~RGE GAS INON-TAXABlftJ. 95 PERI 8 C/COW INON- T AXABLEI PER OAY $ PER WEEK By my initials, I accept or decline Physical Damage Waiver at the rates listed above. If I decline to purchase the Waiver. I accept full re~onsibUlty for loss by collision or Physical damage. regardless of cause up to $ ., ':400.%" _ ,;'- .': per occurrence, which may be charged to my credit card shown below. Accepting reduces my responsibility to $ charged to my credit card shown below. PHYSICAL DAMAGE WAIVER IS NOT INSURANCE REJECTION OF UNINSURED MOTORIST PROTECTION I am rejecting uninsured motorist coverag;e under this rental or lease agreement, and any policy of insurance or self-insurance issued under this agreement, for myself and all other passeng~rs of this vehicle. Uninsured coverage protects me and other passengers in this vehicle for loss and damages suffered if injury is caused by the negligence of a driver who does not have any insurance to pay for losses and damages. per occurrence. which may be $ 3.00 % 2.00' QAY PTAF TAX PERSONAL ACCIDENT INSURANCE SUB-TOTAL Renter's Signature VEHICLE CONDITION OUT PERSONAL EFFECTS COVERAGE ~, 4 Oate I " SUB- TOTAL LESS REFUND FOR: S'AIlE JACK O.K. CUSTOMER INITIALS Total Charge 1..oiiiiii lESS DEPOSITS IN NO DAMAGE RENTAL WILL E PAlO BY GNA. DRC NET AMOUNT DUE AMEX CB/OINERS RO#: I nave read both sides of this ag,eemllnt end agree to its 'erms and conditions. I authorize you to process a credit card vouc:her. if any. In my I'IIIma. THIS IS YOUR INVOICE - PAYMENT OUE ON RECEIPT RiNTER"S ~IUNA lURE EXTENDED TO ADDITIONAL CASH DEPOSIT DATE $ EXTENDED TO ADDITIONAL CASH DEPOSIT DATE $ CHECKED OUT BY: CHECKED IN BY: DIANE JACKIE VISA x M/C OTHER CREDIT AUTH. NO. FINAL CHARGES ARE SUBJECT TO AUDIT W"'~~illlliiIIl'~Jl ~'~l'"~;_J'Ik"_"'_.' Ref#: 148 ..PRI!1'FI\il!lq,..'.,... D1995 .. ,'MAKE'MODEl'YEAR-COlOR DODGE RAM W 99 GRE .UCENSENUMBER I!CP.12.21 ODOMETER IN 11026 ODOMETER ..01JT<i ' ~39'2 DATE AND TIME IN $ 0;00 $ % $ $ $ 925;00 27!75 $ $ 1008,25 $ $ 1008 _'25 $ $ 1008,25 $ $ 1008.25 INITIALS INITIALS GAS OUT IN MILES 0.20 E HOURS @ 0.00 DAYS @ 54.00 Yo WEEKS @ 289.00 ADDITI0IjM~~I'I~~~Ij,."t'I'5ii .'.. /,HCI~~'{l()IjEI'I()c~""T~()~~!!ln' ...'.'.. ); MONTHll @ 925. 00 ,. ,...'G~~~......!'.~.,~~T:~.,..........,...I...,~='~.(:~~ .,'...~..... ; :::~:~:EB:D MILEAGE, CHARGES ~~~ri~:. PHYSICAL DAMAGE WAIVER .=~$_ PHYSICAL DAMAGE ;ECLlljt~ RATE $ 13.95 PER DAY $ 97.65 PER WEEK ~;0~rI2 tNOT ~~~~NCE) By my initials. I accept or decline Physical Damage Waiver at the rates listed above. If I -SUB-TOTAL $ decline to purchase the Waiver, I accept full re~orls_iblllty for Joss by collision or Physical SALES TAX OJi[~RGE t:. nn 9D $ damage, regardless of cause up to $ '.'.- -"':lOu.%.:_ -,",-:. per occurronce, which may be charged to my credit card shown below. GAS INON-TAXABlf>1 o. 95 PER 1'8 $ Accepting reduces my resF?onslbility to $ - ,. . ; per occurrence, which may be C/CDW (NON. TAXABLE) $ charged to my credit card shown below. , PHYSICAL DAMAGE WAIVER IS NOT INSURANCE REJECTION OF UNINSURED MOTORIST PROTECTION I am rejecting uninsured motorist coverage under this rental or lease agreement, and any policy of insurance or self-insurance issued under this agreement, for myself and aU other passengers of this vehicle. Uninsured coverage protects me and other passengers in this vehicle for loss and damages suffered if injury is caused by the negligence of a driver who does not have any insurance to pay for losses and damages. ,hL","~'if~1i0'-~"-q" ~ "W~'~"~_~' .Ili~ "~ ....- ~" ,-~ "~~ -~.- "~jijljjl~_- I CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike . MECHANICSBURG. PA 17055 (717) 690.-1880 (80.0) 382.1436 No. RENTAL AGREEMENT ~' I. i!K'4 !crrY2J~E jT 1.011".<.. \>. LOCAL CONI~ . REPLACEMENT CAR NO. ~MAKE'MODEL-YEAR-COLOR ~L1CENSE NUMBER Ii>> \ \.., .\ 0; CDOMETER IN ODOMETER OUT MILES DRIVEN MILES,.,... ,.,,\WV\'ED . ADDRESS PHONE \l ~ '7 [, '.1.5P'Ii:i~Y '. 3QoOMGlNTl:l EMPLOYER PHONE 9104580552 EMPLOYER'S ADDRESS CITY CHARGEABLE MilES to'\\ 1 STATE ZIP REFERRED BY 7000 ACCT , , I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 on the back of this Agreement. Operation of the vehicle by any driver in violation of Paragraph 6 is prohibited. If nonEl, prir\t NONE across this section. .t. FUEL OUT: FULL $ 2.00 % 2.00 I DAY PTAF TAX PERSONAL ACCIDENT INSURANCE SUB. TOTAL Renter's Signature PERSONAL EFFECTS COVERAGE Dlltil' '.. ..,..,.., ...'. '.....', ....." '.,.. ,.." ~~'~ ^~- -..... '_M 0 _ ~"~~_-,.,1",",:b:' Ref#: 176 ~A~~1"J OI\KHARNO. . ",.. P1Q!!$.. .".,.... .M~f;r.tl![)%~X~I\'l'C[)~OI! OODGERM4W99.GRE t;'<:EI'/SEN~fII~E.~ '... .. '. ' /,',.,t3ct'1227.. ....'/ ..,. .~ ODOMETER ., , , IN _ ODOMETER . . , '.. . . .OVT.llj)76 .., Dq~D~Etqq A. D...,.AT. ~,.,,~O..Jl!>IEO. tJT2.......O:..3.'.Q..., 081tl6>~9. ,....'..". . pc.., .,,'..E)<l'IRA. ~g~:'&i~.U~"21!1.,. ..."....,ru...,.. T.) '''9''>0' ~'. ..."9.. .." )(,. ::,\~;,:,'_,X,:- _::\-':::,~:::;;-:',~::',. :.,-:,-:'-;~:;:-',-:::,~,::i::.,:'::::!~: $ $ $ $ $ $ $ $ \ ~ ~ $ .,' ,~^ ',...;;.. . $ $ $ SPARE JACK OJ(.. CUSTOMER INItIAlS SUB. TO"ML $ ~$ _$ LESS DEPOSITS ' $ Tr.. NET AMOUNT DUE NET DUE RENTER WARNING I hllve read careft.iIlV all driving and use restrictions on the reverse side. I am respo!'lS'lble tor ell tratlic violatiol'l$ and mvst turn in all $ummOJ"lSti upcn return of vehicle. I wm report en eecidents immedlatelv. VEHICLE <;ONDITION, . OUTNO DAMAGE.. " IN REN IAL WILL B. .,,10 By..,. GNA ... '. ...', ..' .,.,,' " PRC AMEX $ $ t;BIDINERS RO#: I have read both sides of this o!Igtelttl'lent and agree to its terms al"ld condlt,ons. I authorize you to process a credit Co!Ird voucher, If eny. in my neme. THIS IS YOUR INVOICE. PAYMENT DUE ON RECEIPT RENUft'S 51QNA11JI'IE EXTENDED TO ADDITIONAL CASH DEP(J.l:iIT DATE $ EXTENDED TO ADDITIONAl CASH DEPOSIT DATE $ CHECKED OUT BY: JACKIE VISA x M/C OTHER leREDIT AUTH, NO. DATE IAMOUNT I AUTHORIZED BY: I TIME FINAL CHARGES ARE SUBJECT TO AUDIT INITIALS INITiAlS I CHECKED IN BY: "","~Idl't~ ~.~~ "~~O ~""""" " ~. . '" ~ . \\\C\ '-"'IiIi/ill4l1lj-g;ffiiilAi\l'~~*'_"""'"='''f,''.f",jj;,;:j;" -J l./UOI U RENTAL AGREEMENT ... 1~~t\!OCI;"~O ~,..~~ ~_~ :::::::::::LDR ~~~~R ' CITY A \" f"'L ~T~ ,\ _ .. I ,.., ZIP CODE LICENSE NUMBER WC~SEJi.Ul ill- t '(\'" ,1'""\f1 \""'""tL \ '\ n I~{' -, ~~l)~ N '~:J \ '_:'\.'1 I DRII/ER'SLlCENSE~<T.;... ~ ('I ,J<P,~, - ODOMETER l'2..c "7""2 ~ ODOMETER ...,,,,, 'r~\( ^ ~ \ \-\\-c: )\ IN 11l..:Ll IN "),n V J BIRtHUj\\ L.l.IA SOC1Al.SECU~NDq\l\l\;'OM8HDNE -{'D'i,'i'W'ER l1~l.~Q(') D"'6"J"'R 'i1l'1~ LOCAL CONTACT ADDRESS q\D LlC:;ATJ7Ltl ~~$ D7iAii'1/QQ ~ EMPLOYER PHONE 4'~1~ ~~ DOANis.1:O ~~~: EMPLOYER'S ADDRESS -; ;..~'!E DUE . CHARGEABLE c::.....J ,J '0 EXPIRATION OF AGREEMENT . CITY STATE ZIP I REFERRED BY MILES 1.,.)'..P'-1 "Q....,,'~ "M, f'DI'f~RE:~N.PR\lJ \ HDMEPHDNENO\\i";\"GH1A : l> ~ '1'. DR1:tt\NO NO STAT~Y E,y\\p\\. , Gas [Taxable) ~~llt~s PHYSICAL DAMAGE WAIVER ~:rm.:.r,;s t\~ INES f'\c:: t""\ I.'C ACCS'TS "1:,)--' RATE $ Vn"""_""ERDAY$~~WEEK X ~ my initials, I accept or decline Physical Damage Waiver at the rates listed above. If I declin~ to purcl1ase the, Waiver. I ~~c~pt full res~sibil,i_ty for loss by collision or Physical damage, regardless of cause up to $ I rY~ per occurrence, which may be charged to my credit card shown below. Accepting reduces my responsibility to $ '0 per occurrence, which may be charged 10 my credit card shown below. PHYSICAL DAMAGE WAIVER IS NOT INSURANCE PERSONAL ACCIDeNT INSURANCE (P.A.I.) R'.....'S By my initials, I accept or' decline enrollment for Personal Accident ~Ai..S- urance. It , accept, I understand and acknowledge that cov~s ACCEPTS at t s indicated and that I have read the certifiea nsurance ~fur;:~:d$b~rental~ PER WEEK X " RENTER'S PERSONAL TS RAGE (P.E.C.) RENTER'S INITIALS By my initials, I or decline enrQJIl!]P Personal Effects INITIALS DECLINES Coverage, If , ept. I understand and dCknowledge verage is ACCEPTS at the indicated and that I have reaer-the certificate of ins f . ed by dealer prior to rental. . ~ X /"" RATE $ PER DAY $ PER WEEK X Sub-Total $ ..ffiiIClECON~tO~ " f ,"",-I"\. ...... N' SPARE CUSTOM~R Less Refund For: $ OUT I '-If''\ \ A}fl ~ll, JACKO,K INITIALS ." .- $ l.~~ &lllk:.,. (-,::A ~e.L_~ DepoSits '$ IN f)uu .r'It;r; . A. I'A 2 ~ I. . ,'" RENTAL WILL 9E PAID BY ,-V 1-R.. ~ ount Due $ 1,......... ..-....,..- f{t- i f I~L 7 ,IA ~Due RenIer $ Il ~~ j"WARNING . I have read carefully all driving and use restrictions on Ihe reverse side. . I am responsible lor at! tratlic vkllations and must turn in atl summonses upolI return ofvenicle. . I will repon all accidents immealately. ~ ( GAS OUT IN I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 of the back of this Agreement. Operation of the vehicle by any driver in violation of Paragraph 6 is prohibited. If E none, print NONE across this section. ~ ~R'S INIT~ DECUNES X DRC , AMEX CBlDINERS VISA MIC OTHER CREDIT AUTH. NO. I TIME I AMOUNT I AUTHORIZED BY: I DATE E ..... '" Mil Hours., @ I Days /.i @ ~ -I .L"){ ) Weeks"~ . c:r\ MonlhsLM <. ~m Total Time and Mileage Charges PHYSICAL DAMAGE WAIVER (NOT INSURANCE) Sub.Total Sales Tax or Surcharge ~" ;:;),rY-:>fr\t'lJ...o. Vl I Gas (Non-Taxsble);:::$ .7-.0 ' a.n i C1COW (Non-Taxable) " PERSONAL ACCIDENT INSURANCE Sub-Total ~ Jr}fjJ 1 r .J:?~["'TJI P COVERAG .~ Ic.pt.f " $ $ $ $ $ $ $ $ 1M 'l 1 tV)" $ I I I I I IIY c;::.r ) Uf' .-;;q $ $ $ $ .7/ ~{.s. ,- $ $ '-t UlI......IU ?>ilb'L-!1 "'8 pO $ ': h'f'. I halle read both sides of this agreement and agree to its terms and conditions. I authorize you to process a credit card voucher, If any, in my name, T'flS IS YOU~ INVOICE. PAYMENT DUE ON RECEIPT "'!..." ~~ x.' '1\\:TT-..A 'I ... /1 RENTER'S SIGNATURE EXTEND TO ADDITIONAl CASH DEPOSIT DATE INITIALS ---- EXTEND TO $ ADDITIONAL CASH DEPOSIT DATE $ ~ > ? c UT r , ; INIT CHECKED IN BY: -"-'.~".'" ,~""..." , . RfN Al.:'A~REEMENt ;(,,~, 0. '?::J'j' '\1' --- ~~. ' ""~""~*_...... ... ~~'oIliIIIliiI!iIl ~ ,- - ,~~~~,,,,;,,;,,,,,,,,,,>>,,,,,,,-,,~, ( AENTEA~U\f'~ "MI'.('\l ,fv\r.rn'r-., HOME A/!':5 , ~ A CITY lA_ rl'U.n DRlveR~~'l..,c;,q4- ST ~A ' I 'lI!l:!f i~ (j;.j;i, soetAL SecUA,1lY NO, CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717),691-1880 800-382-1436 ",,\l., \~ 4- \Go' 64081 7 REPLACEMENT CAR NO. -\T _ _ _-.+- \~ 1'-'\,1} ST" N- 'Ri~. - ."C-f r~s~ '1.(,:~\~6~ MAKE.MOOEl.YEAA-COlOR L.ICENSE NUMBER ODOMETER IN HOME PHONE , . ODOMETER OUT LOCA CONTACT "~ hv"l E,?"" EA I . l..:r \C-n'r\. " EMPLOYER'S ADDRESS C\ \0 ~5F. r ,\:; 5":2 T (" k ~,- 'J" PHONE MILES DRIVEN :''1'\\ MIlS ~ AWlWED - ~ ' ~~ OUT'N~ Hours@ $ $ I E E Days @ $ $ , III III Weeks @ ~$' , ADDI~O,\,\"~RNAM\,,\7': ..~M""I\ONE'';,.:._~AfEO~''',,! Y.I 112 Monlhs\@ ~ $ ~jc:::;10 _ lA \ \ r.,.I'O 'r \ alV , ('\) ("I ,m-; / ~ % Tolal Time and Mileage Charges $ \ -::J. 1 ;;l ~ DR,veR'S _)1._- "~ER '-IST~UNTR~ -A" ~~DA:'" IF 'F~h $, ( - l rv"'\V"\ 1\ 'T" / Gas (Taxable) $ I PHYSICAL DAMAGE WAIVER ~~ PHYSICAL : X~S S \,..., n'C:""" a r~~ ACCEPTS DAMAGE WAIVER $ , . " RATE $ \ -::) '-'J PER DAY $ -, t W,"7PER WEEK x (NOT INSURANCE) : By my initials. I accept or decline Physical Damage Waiver at the rates listed above. Sub. Total $ \. ",.J. \ rJ.. ! r ~ "'- If I decline to purchase the Waiver, I accept full responsibility for loss by collision or comprehen- Sales Tax or Surcharge ~ 0' $ \ (J 0.. I \ ~ sive damage, regardless of cause, up to $ \ DO% per occurrence, which may be Gas (Non-Taxable)!.l. ,r;:;U ~ \ $ I charge~ to my credit card shown ~elow. "........ __ _ . C/CDW (Non.Taxable) $ Accepting reduces my responsibilIty to $ ~ per occurrence, whIch may be I n <:.J' I charged to my credit card shown below. 1!..Io. Tn ~ PHYSICAL DAMAGE WAIVER IS NOT'NSURANCE. crCO~"\-.~ ~R'\- "T"'j(. - @."'.', PERSONAL ACCIDENT INSURANCE (PAl) ~, I """"'"' initials, I accept or decline enrollment for Personal Accident. ~ PERSONAL ACCIDENT $ 1 DECLINES !nsura . I ac.ce .1. I understand and aCknowledge lhat co~ ACC'E..tIT<! INSURANCE : IS at the rat cated and that I have read the cate Of ...., .... I insurance furnisheO' ler prior 10 rental. I Sub.Total $ I X RATE $ PER 0 PER WEEK X I I ~~~s PERSONAL,.,EiPFECTS COVE PEG) . ~... I By my iniltals I~ or decline enrollment for~""1 Effects PERSONAL EFFECTS $ : DECLINES ~b~!'~;ci~~~a~~dn~eri~t~g~t ar~;::~~~~dt~~ t~~~ ACCEPTS COVERAGE : / ~l;e rf~l~mShed by dealer prior to rerj~ar. '- Sub:Total $ r I y ~ RATE $ PER DAY $. PER WEEK X "- less Refund For; $ I VEHICLE CONOITl~- _ _ SPARE CUSTOMER $ , ""'\..J.. , 1,--", t OUT V"'"\.,. ... I fA ~ . JACK O.K. INITIALS Less Deposits $. r- U -- Net Amount Due $: IN .- LAr T'\ -E::... I AENTALWtLlBEPAtDBY Net Due, Renter $ t WARNING . I have read carefully all driving and use restrictions on the reverse side. . I am responsible lor all traffic violations and must turn in all summonses upon retul'n of "ehiele. . I will report all accidents immediately. I have read both sides 01 this agreement and agree \0 its terms and c.onditions. I authorize you 10 process a credit card voucher. if any, in my name. PHONE CITY STATE ZIP I REFERRED BY I will not under any circumstances surrender the use of the renled vehicle to any person other than those listed below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. If none. print NONE across this section. """"," '"""'" I(jJ~ DRC AMEX CB/DINERS M/C THIS IS YOUR INVOICE. PAYMENT DUE ON RECEIPT X C<\l:~" r,_r, (...;~ lJ"J,j,r l I RENTER'S SI(lNATURE EXTEND TO ADDITIONAL CASH DEPOSIT DATE . - ,... VISA INlT1AlS OTHER \c.o\ ~r~u~ TOATE -riME EXTEND TO ADDITIONAL CASH DEPOSIT S DATE INITIALS C~EOIT AUTH, NO I "'MOUNT AUTHORIZED BY: C~p\ BY: CHECKED IN BY: ''''l'''''''l' ADAmSD 'lI'J:Ilm..'" FINAL CHARGES ARE SUBJECT TO AUDIT CUMBERLAND VALLEY MOTORS 672~rliSle Pike MEeHANI BURG. PA 17055 (717) 691-1 ,0 8,00-382-1436 \1\\ \L1-2.<t 4lw A:~ -ill~L "llll'llmJA/"'"J" ,.'. AEPLACEMENTCAANO. ,":~3-~ ir'. \}~ Rl.-.{) MAKE.MODEL.YEAA.COI.OR CI1[O ~ A II' .' ~ , I-t'~ "CENSE NUMBER jjjif"~EA;UICENSENO., nll ~ -...-'f~L =" LO ;(-T11.,- <1v"..' J .~'I.(ru ~ i ~ J A~ SOCIAL SEl UA'TY NO, HOME ~NE, . . , OD'b~TEA LOA} CMK~^ '~ms:~~ _ nt::.C. -i-HONE ~lo~~ III ~~\tmft. IIL ICJ. ~OYE~RE~ 0 lO' UL{: J. 0& 7s 1 REFERRED BY ~HAAGEABLE EXPIRA~'6,.~eeME,;g1 MILES - ,- GAS OUT IN Miles @ e$ I Hours@ $ '$ , EO.ys @ $ $ , Weeks @ S", $ , Months \@ $-'-J.',.V'" $ Vl:;'(""l!CfJ Total rime and Mileage Charges $ Lt. J 1:'1 rY"'"\ $ , Gas (Taxable) $, ~J' L/ PHYSICAL DAMAGE WAIVER I ',~ PHYSICAL : X~"NiiS f"l .q r' a I . - I ' ACCEPTS DAMAGE WAIVER $ , {"- RATE $ d. I"J PER DAY $ -/ 7, \p ~ PER WEEK x (NOT INSURANCE) _ : By my mltlals, I accept or declme Physical Damage Waiver at the rates listed above. Sub-Total "$ ~'W- If r dechne to purchase the Waiver, I accePtf~il.~~~O~thty for loss by colliSIon or comprehen. Sales Tax or Surcharae ~ $$ '2.1, ..cG- siva damage, regardless of cause, ufo to $ //'J/J v / ~ per occurrence, which may be Gas (Non-Taxable) . '. '-SJILL charged to my credit card shown be ow. _ If) _ C/CDW (Non-Ta)(a'5"l~ ) --' $ I Accepting reduces my responslblhty to $ per occurrence, which may be I. ..-:z ~/.A I charged to my credit card shown below I ~ PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. r:u.e:.a. . ,I' ~~s PERSONAL ACCIDENT INSURANCE (PAl) REHTEJI ... / / / ... ---- ~8Y my initia~JS' I accept or decline enrollment for Personal Accident ~ PERSONAL ACCIDENT DECLINES nce. if I accept, J understand and acknowledge that covACCEPTS INSURANCE is at tes indicated and that I have read the c .. ate of insurance tu . ed by dealer prior to rental. r Sub-Total RATE $ DAY PER weEK x I l PERSONAL RAGE (PEC) ~.- I By my initials, I I or decline enrollme Personal Effects 'PERSONAL EFFECTS $ : DECLINES :c~overoae. I cept, I understand and acknowl ~.'ll.:: li;!,L~gve.rage ACC.-S COVERAGE \ is at ates indicated and thai I hCW8.lead tile cef'tIMaLe of o;r' I i nce furnished by dealer prior to reti~ar. "~Sub.Total $: X ~ RATE $ PER DAY $ PER WEEK I X --........... less Refund For: $ r VEHICIoE1(QNOITI'1/l IAAA ,. SPARE CUSTOMER ~$ \ (J 71-":...J.. ') OUT r' 0 JACK O.K. INmA.lS Less Deposits $ I IN A-J Y re.., Net Amount Due $: RENTAl WILL BE PAIDlif' Net Due Renter $ I WARNING . I have read carefully all driving and use restrictions on the reverse side. . I am responsible tor all traffic violations and must turn in all summonses upon relurn of vehicle. . I wilt report' all accidents tmmediately. I have read both sides of this agreement and agree to its terms and conditions. 1 authorize you to process a aetln card voucher, if any, in my name. w,",,~c"-' '"""0" _'~~ "".~ JIiIIl" . ~ .~~...,. ~~ ~","'.' ~ R~NT.I!MENT ( PHONE CITY STATE ZOP I will not under any circumslances surrender the use of the rented vehicle to any person other than those lisled below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver 10 violation of Paragraph 6 is prohibited. If none, print NONE across this section. E ADOki1"~TE~j) /1 J; I ~O'}JP"Wfj JI '~TEXBli :: omv!!A'SLITMBE~1 0 II j.r; -1\ IJIP.J If, ~iTlONiTE,~ ICF x RENTER'S ..""" '10:). cs- . DAC REJECTION OF UNINSURED MOTORIST PROTECTION AMEX J am rejecting uninsured motorist COV....g8 under this rental or luse agreement. ertd any policy of insurance or self..inlurance issued under thil agreement. for myself and all other pusen.. gers of this ..-ehicle. Uninsured coverage protects me an~ other passengers in this vehicle for 101S and damages luffered if injury is caused by the negligence of . driver who doe$ not have eny in$urance to pay for 10.1.. end damages. CB/DlNERS VISA M/C 0.. D" . R~nt.". VI 'VV1 UV),.,. I V P SlgnatuM )LI v I L DMo I I OTHER CAEOIT AUTH NO. TOAT~ AUTHORIZED BY: ~ TIME -:;- AMour>lT ~"" ~~_....... ' - Ii'.......~"' """"rt ~~ ~~- ,~ 641007 OOOMETER IN ~:l ~rl/:"S L~E NUM~.n:t ~I J- ;). -In"! {II =r.ETEA VJ ;;)'-\- ~ ""'b"uF t()~:, rl2'M V.qF~ ;~ -)~f:19. ,Jj::ij MILES DRIVEN 'In. r~1"1. \ \. \(71 ~. . ~ 11) .. MILES ALLOWED --.- , $ , , , , $ , "'IS YOUR lNVo:;e:.'A YMENT DUE ON RECElPT~ .. x"xI 01/l UY1JHl I ~ '1)( r\ I\EtImI'SSlGNAlIlllE' , eXTeND TO ADDITIONAL CASH DepOSIT DATE . INITIALS EXTEND TO tNITIALS ADOITIONAL CASH DEPOSIT . DATE CHE~.1 Y , CH~Ip\ ''''1''''...>1' A.OA.msn 1""12lH'" FINAL CHARGES ARE SUBJECT TO AUDIT l~R""'"'''' iiUlIj.-~ ~"-~ Ow .<"'. .~_~ - . H~ f~$kl!i""" "","",J._"~~' .' .. RENTAL AGREEMENT ~. . ~~, .,~ CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG, PA 17055 (717) 691-18,80 800-382-1436 OATe:OUE - ~HARG'EABLE IRAllONOf EEM '. _ . MILES llD \. . .,... . , GAS OUT IN Miles ' c: '$'" '- ;, ,I Hours@ $ '$ I E E Days @ $ $ I 14 v. Weeks @ $ $ , ADD!~ALAENTEA~M. (>. n HOf',\PHONENO, DA1'E']!;.'A": v.. Y, Months' @ _rY~ $ lA\\ ()r ,\\-o,er\! c1r'~"'"l r3t- j,;'. % Tolal Time and MUeage Charges $ DRIVER'S L ,_ ' ^ UM8 STATEfCOUNTRY EXPIRA:/TtON ~TE I '-" F $ lJ"" I\. j Gas (Taxable) $ ~~s PHYSICAL DAMAGE WAIVER ~ PHYSICAL DE~S r. ,.r...C' i'l<:CEPTS DAMAGE WAIVER x ^ RATE $ \ ::;.q5"PER DAY $ ~ PER WEEK X (NOT INSURANCE) By ~ initials, I accept or decline Physical Damage Waiver atlhe rales listed above. Sub-Total $ If I decline to purchase the Waiver. I accept full responsibility for loss by collision or comprehen- Sales Tax. or Surcharge J TJ I $ sive damage, regardless of cause, up to $ I(J(JI.. per occurrence, which may be Gas (Non-Taxable)ol,&lJ/ ntJ1. ~.- $ charge~ to my credit card sho~n. ~elow. ,r:.. . C/CDW {Non-Taxable I I $ Accepting reduces my responsibIlity to $ ~ - per OCcUrrence. whIch may be ~' , charged to my credit card shown below. I . PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. ~. UV (A u )( ~ PERSONAL ACCIDENT INSURANCE (PAl) '~~ I I . 11. ~~:lIals, I accept or decline enrollmenl for Personal AccIdent .............- PERSONAL Ac?P!DENT DECLINES l~s~!i:I;.~ If I accept, 1 understand and ackno~,ledge that cov ACCEPTS INSURANCE IS at the r dicated and that I have read the ~ate of insurance 1urnisli dealer prior to rental. Is ub. Total I RATE $ PER PER WEEK PERSON~CTS COV~ (PEC) By my IrlltJals ~t or dechne enrollment fo sonal Effects DEC' INES ~over a accept, I understand and acknowledge overage ACC PTS ... IS rates Indicated and that I hcw&"ead the certl~ ot E ! -'" urance furnished by dealer prror to reoltal ........................ Sub-Total $ ~ RATE $ PER DAY $ , PERWEEK'x ~~$ VEHICLECONOITION t\ SPARE CUSTOMER_$ OUT ~ J I"\C. ~ oJ' JACK O.K. INITIALS Less Deposits $ A:lli~~ "^:r 'i.... HCj~p:' A'. \ \ CITY I\J\ _ I J.LJ{ , DA~~c~/l c'G L\- STATep 4TH ~ ~C;t SOCIAL SECURITY NO. ''J"I\L CONTACT . ' ADOAESS o -e(\-\ A, .,\ - (;.'TA r _\, ~ Er;:').oF;~S AO~~S~ \ _ I D "\1" IU",:,-\!\. , W;. \~ ~(""''''\ ,lh'C:. C6.,t""v\\ '-(:" &~TATENL. ZI'g b ~_\. ,rA ~..1 S\Al"I ^ \ --. . ZIP cooe . \-' fj- .\ IG~" t '1. (') ,P. ~~ HOM~ PHONE , PHONE c..VJ ~~D;Fn'2 FE,RRED BY I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 ot the back of this agreement. Operation of the vehicle by any driver Ir1 violation Of Paragraph 6 is prohibited. If none, print NONE across this section. x X RENTER"S ~m.wI RENTER'S INInAlS v IN RENTAL WILL BE PAID BY "lD:i .~ ORC REJECflON OF UNINSURED MOTORIST PROTECflON AMEX I am reiecting uninsured motorist coverage under thil, rental or lease agreement. and any policy of insurance or self-insurance issued under this agreement, for myself a,nd~, all other passen- gers of this vehicle. Uninsured coverage protects me and other pas.sengers in this vehide for loss and damages suffered if injury is caused by the negligence of . driver who does not have any insurance to pay for loues and damages. CB/DINERS VISA MIC OTHER RenIer'. L"..~. 1 l' \ .0 ft-Ie Signa.ure 0\ l\ h '^'" r I "- - ( ( CREDIT AUTH NO I DATE I TIME I AMOUNT I AUTHORIZED BY FINAL CHARGES ARE SUBJECT TO AUD1T - CHECKED OUT BY: "'\\'\\ ""'''''-<'1' ADAmSn '''''''111<>''. \t. ,\ 1...\ ?1b \..t , c.. REPLACEMENT CAR NO. ORIG'l5 \'Ur G'\ ~booe\~~6 6 ~~NU:~'OqC, DDD::,ETER I '1 ') 4-=3 " ().,5 't~ MAKE-MODEL.YEAR-COLQR LICENSE NUMBER ODOMETER 'N ODOMETER OUT MILES DRIVEN lf1D\ r).. -- MIlES Auoweo 'PERSONAL EFFECTS COVERAGE Net Amount Due I~_<il'f='~"",,"-, M~.iIr. :1l>"~"'~~, 641277 ODOMETER OUT Dt1:Nj TIt !'jqq ~ D\\jl't1iqyJ 5~ $ -~ '1Zh J(} I Lf'K ?~ v, : I I I I I Il{''-,{I~ I-:G/'tQS:. I I ........ .-.- $ $ $ .. I' , '"1 'T"' $ Net Due Renier $ t WARNING . f have read carefullv all driving and use restrictions on the reverse side. . I am responsible for all traffic violations and must turn in all summonses upon return of vehicle. . I will report all accidents immediately. I have read both sides of this agreement and agree to its terms and condilions. I authorize you 10 process a credil card voucher, if any. in my name. x 6il\' \ , EXTEND TO rHIS IS YOUR INVOICE - PAYMENT DUE ON RECEIPT _.t :r G'-V~=r RENtER'S SIGNATURE ADDITIONAL CASH DEPOSIT S EXTEND TO ADDITIONAL CASH DEPOSIT . DATE INITIALS DATE INlTlALS CHECKED IN BY Oc'--- ~..- '" ,~..,,"--, ~ ~~, _~ _.~~ _~ o_'_'~ "-',",'",,. - . 'ri;o~ . RENTAL AGREEMENT '(l (717l691-18~0 R~~ lhl)OP\\~ "0MF"3-~ A. UP(\'\. rI- Qd cAil\rlA J D:9~sNnT'!1 Ll B:1" i':2. f n 9- l,oQf~'" Cf'~T/'::;T. -:- , _ I\.J'IU K VI, (\ I-' l;."T1l n 1'E1'(:;'NA 1U~ Cl ~() - 4<Zf6 - .05<; d.. \~1G\ADD~ i 6 It' () 0" b II . -hH>J I T\f\N I M ,~t1 ~T;:'E ~ 1r ,ZI.,-?ti A_~R~RREDBY ,. " ._OolU*.. i;.lIllll!l~.-w...~"bl!:E- CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 800-382-1436,^(Y.A~ 1(0 F1EPl..ACEMENT CAR NO. E E V. V, ~' NAL R "r; DATE 0; BIRm, III V, / / t9'll % DRIVER'SLICE '~~BER ~~STATEiCOUNTRY EXPIllA:""'D~TE' IfF I\\- F1l\}t / / -- Gas (Taxable) ~ ~ PHYSICAL DAMAGE WAIVER ~s PHYSiCAL ~NES . r,.- OJ '^I ACCEPTS DAMAGE WAIVER X "- RATE $ Y\ '-> PER OA 'i" ~ W::) PER WEEK X (NOT INSURANCE) a/my mlllals, 1 accept or decline PhysIcal Damage WaIver at the rates listed above Sub-Total At. If/! dechne to purchase the Waiver, 1 accept full responsibIlity for loss by CollIsion or comprehen- Sales Tax or Surcharge \I.~/:. sive damage. regardless of cause, up to $ lr:;(")% per occurrence, which may be Gas (Non.Taxable):1';;rl r." \ charged to my credit card s/1own below. --1""'\ ~ C/CDW (Non-Taxable) .Acceptlng reduces my responsibility to $ --t;,II per occurrence, which may be I charged to my credit card shown below. I PHYSICAL DAMAGE WAIVER IS NOT INSURANCE, Li.-( Y'l \ ~..... n,', PERSONAL ACCIDENT INSURANCE (PAl) ~ ' ~'niliaIS' ,I accept or decline enrollment for Personal Accidell1. ~ PERSONAL ACCIDENT OEC~INES Insuran. acce t, I understand and acknowledge that c e ACCEPTS INSURANCE IS at the rate . jcated and that I have read the cate of insurance furnrshe ealer prior to rental. I Sut).. Total X RATE $ PER D ~ER WEEK X r A=rii~~s PEASONA~TS COVER PEe) ':~~S ". .. ~BY my initials, ~ or decline enrollment tor al Effects PERSONAL EFFECTS DECLINES Cover a accept. I understand and acknowledge tha erage ACCEPTS COVERAGE is rates indicated and thaI r ha~ ~ad tne cermic of I -",,' urance furnished by dealer prior to rertt;1. ~ Sub-Total I~ RATE $ PER DAY $ PERWEEKlx--...........~ VEHI~___ .0 SPARE CUSTOMER_ OUT ~ \f ) Kml'f l1" J JACK O.K. INITIALS Less Deposits ~,- ;?, IN .. ...\0"',.......... RENTAL WILL BE PAID BY 1 -:TE ST(~ \-1P~S l ~ .,DA1\7"\ . t.UV HOME PHONE SOCIAL SECUR,fTY NO. , ADDRESS PHONE I will not under any circumstances surrender the use of the rented vehicle to .any person other than tttose lISted below (lr in Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver In violafion of Paragraph 6 is prohibited. If none, print NONE across this section. GAS OUT IN r'DI~ hD2f, ORe REJECTION Of UNINSURED MOTORIST PROTECTION AMEX I 8m rejecting uninsured motorist coy.nga under thi, rental or lease agreement. and an)" policy of insurance or self-insurance issued under this agreement. for myself. and all other passen.. gers of this vehicle. Uninsured coverage 'protects me and other passengers in this vehicle for 10ls and damag.s suffered if injury is caused by the negligenee of. a driver who does not have any insurance to pay for losses and damages. CBIDINERS VISA. Mle g~ 6Y\ ~lQ. OTHER CREDlT A.UTH NO TT1ME AUTHORIZED BV -, AMOUHT DATE MAKE.MODEL.YEAR-COLOR 641459 ~ LICENSE NUMBER ODOMETER IN L ~EIR NUM8~ A, ",n ( fA.... - :;(-'tr-un ODO::,ETER ~O\O~ 11~3 ;2~ SO) D TE A1 T~J'~ I q ~~ "-rYI I\Jf~t5~~ ~ '~DATEDU. ( ./ ~l1ON AGREE ODOMETER OUT ODOMETER ,OUT MILES DRIVEN MILES ALLOWED CHARGEABLE MILES Miles @ Hourn @ $ Days @ $ Weeks @ $^ Months \ @ $ Total Time and Mileage Charges e $' J $ I $ , $ , $ '--\ :..U.. UC7 $ c;>,-:;z ,,., $ $ {J.,'Y, .ny , , , , , , $ L-\,..,.,., 'CY J $ z;:;._-~'a,~ $ , $ , I $ Net Amount Due , , , $ , , , $ , , , , $ , , , $ : $ , -- $ \ -" (;I.,"') $ , , $ , , Net Due Renter WARNING . I have read caretully all driving and use restrictions on the re\le~ side. . I am responsible for all traffic violations and must turn in all summonses upon return 01 vehicle. . I will report all accidents immediately. I have read both sides of this agreement and agree to its terms and conditions. r authorize you 10 process a credit card voucher, if any, in my name. $ . ~ YOUR INVOICE. PA~e:: ~'t..~ ~E~r {' ..(,..rr. I) X ~(V'\(!1\ 111 V\'l' 111" l{)'-\{IJI ~ . RENTER'S S1GNATUR EXTEND TO \ IDcmONAL CASH DEPOSIT DATE INfTlALS EXTEND TO DATE INITIALS ADDITIONAL CASH DEPOSIT . CH~ QklT ev: ~.v . ~8Y ,..'\""....11 ADAmSD llOO\llJ...'" FINAL CHARGES ARE SUBJECT TO AUDIT ~j.",;,d-""~ H..J_,=~~ . ~__ _~"""'~~. __'\ v " .. R~NTA~GREEMENT J _"" .~~ -",. ~ ...... Iii' "'r<;_ -~ "4"""="'~""""""''''"'<'llil!fuJt!:."''''.(_'; CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG, PA 17055 (717) 691-18&0 800-382-1436 I .~\-::l..,lpl,t\1 A REPLACEMENT CAR NO. ORIG-D l\ LA MAKE.MODEL.YEAR.COLOR ~M~S~ Z~~"ic.Q1 /) -J'"I\ \ OOOMEWl ~ ~ ~O:~Tr'7\C~ DnEX~ fu ~ DATE DUE . CHA~~rsBLE. ~ '.=sRAi ~AG.-..c AM GAS OUT IN Miles @ 4:$ 1 HOllrs@ $ $ I E E Days @ $ $ , 1414Weeks@ $_ $ , AD!lWONAL R~ME HO~~N~.. DATE OF B1~ 10 V, Months' @ $'-1", I. .,-c.fJ$ c;;.:..L ~ 'f' ')1' '') LJ LL.- ( :,"", "- \ . ~\:::-'" \ I ~ J<o.. Tolal Time Bnd Mileage Charges $ r.> r) DRIVER'S LICEN~U~R (, _.. I ~ATElCOONTf1Y EXPfRA']"" DAJE'( F" F $, l)""'\t- l t~ -, / / Gas (Taxable) $. ~. PHYSICAL DAMAGE WAIVER ~~ PHYSICAL : I ~ES ,.,Ac::::. ~ f.C:- ACCEPTS DAMAGE WAIVER $ , 1';/- RATE $ );"'t.luPERDAY$ '---f I'~PERWEEK X (NOT INSURANCE) _: By my initials. I accept or decline Physical Damage Waiver at the rates listed above. Sub~Total _. $ '-1. dh ~,....... Jr-) If I d~ctine to purchaow the Waiver. I accept full rjS,tfji'ity tor loss by collision or comprehen- Sales Tax or Surcharge r "4IV $ c;;,,-:~ ~ t::'" sive damage, regardless 01 cause. up to $ per occurrence, which may be Gas (Non.Taxable.hJ. s::r)/ (/J..{), $ ......... I ....., charged to my credit card shown below. G C/CDW (Non-Taxable) -/----s $ Accepting reduces my responsibility to $ per occurrence, which may be I I char.ged to my credit card shown below. I..;.} l ..-J..-o. PHYSIC";' OAMAGE WAIVER IS NOT INSURANCE. 1J:.J,7lYl rlfl I U ....+IJ.. 1, ..-r ~:=J~s ~EASONAL ACCIDENT INSURANCE (PAl) ~s I ,I.. - (J I By my I .. Is, I accept or decline enrollment for Personal Accident.-;' PERSONAL ACC!OE:NT $ ! DECLINES Insurance. ce t, I understand and aCknOWled~ge that coverage INSURANCE I is at the rates 1 . ted and that I have read the certificate "'"1l.CCEPTS : X ::~::cefurniShed~~le~p~iortorentar. PERWEEK x rSUb.Tota, $; ~~s PERSONAL EFFECTS E (PEG) R=.J~S ~ I By my initials. I accept or e enrollment ersonal Effects PERSONAL EFFECTS $ I DECLINES ~o~rrfhaee. r~ I acce lcated a:~t~g~t ar~:~~~~dt e at.~?~~ago~ ACCEPTS . COVERAGE : ~urnlShed by dealer prior to renl~l. I Sub-Total $! X ____ RATE $ PER DAY $ PERWEEKh-... ~$. ' \lEHICL.E.,EOtDlTlo-w.... SPARE CUSTOMER_$ \('Y-..S<lr,...J h OUT 1'11"\ DAm CQ,.E. JACK O.K. INITIALS Less Oeposits $ \ r-_ -- e IN ....YA-n,1 RENTAL WILL BE pm BY -,(~S ( RENTER(PRINTJ """'"'\ ... .. .... " //>..y\'t-. 1\/\ Ae.vi\fll .0 72Q.. l1 ,1- M ~/I /1 OftTE DRIVER'S3'~~ -, 1/ ~Gl\ f'A BJ~DiT~~ 1 () Q. SOCIAL SECUR.nY NO. L~ CO~~; f? f-i ~Y ~_ ,Inn PHONE HOME AODR&&S"' -.... ,'Vt . 12'h_ Zf~ .:.o~ I,o~"'" l- ~l-ffi CITY HOME PHONE ~ t ADORES~ 1"-1 p<o..:.I, f- L q\('-, 4-==-DH~N;....--. '""' =LOt~QESS N ,\ I n~ ?c.P..... P1.vr;=. ~f?L'UI,./L) <? -~ ~T~ Nl\ .....;..1~EDBY I will not under any circumslances .surrender Ihe use of the rented vehicle to any person other than those lisled below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. If none, print NONE across this section. DRC REJECrlON OF UNINSURED MOTORIST PROTECTION AMEX I am rejecting uninsured motorist coverage under this rental or lease agreement, and any policy of ins\lfanc& or self~n$U'ance blued under this agreement, for myself and .11 other passen- gers of this vehicle. Uninsured coverage protect. me and other passengers in this vehicle for loss and damages suffered if injury is caused by the negligence of . driver who does not h.n any in.u,anee 10 pay fo, 10sse~ dam.ges. R~nle"!- ~ _ ~ b. f\ ^. Slgna~'ln., "'\H. .LlJL CBIOINERS VISA MIC OTHER 641611 LICENSE NUMBER ODOMETER IN ODOMETER IN ODOMETER OUT MILes DRIVEN \0...0 \ ~ .' "Y't 1r.., MILES ALLOWED Net Amount Due $ Net Due Renter WARNING . I have read carelully all driving and use restrictions on the reverse side. . I am responsible for all traffic violations and must turn in all summonses upon return of vehicle. . I will (apart all accidents immediately. I have read both sides of this agreement and agree to its terms and conditions. I authorize you to process a credit card voucher, it any. in my name. $ ~ YOUR INVOICE. PAYMENT DUE,ON RECEIPT ~MhF" \.- 'tL lliY6Si8 ~ RENTER'S SIGNATURE EX'TE'N'r:rTO ADDITIONAL CASH DEPOSIT DATE INITIALS . ADDITIONAL CASH DEPOSIT $ DATE INITIALS CREDIT AUTH NO I DATE I AUTHQF=llZED BY ~ CHECKED 0 ...--- -I FINAL CHARGES ARE SUBJE~I""T C ~_~ '" I jTIMV I AMOUt~ '''''00'-<>'2' ADAms II ,&(12')]1-<>'" I~~ /,-./ ~ ~. .--- - ~,~ i ~^ - ,-, ~"'~"'~"';;_:_j~",,,-~ CUMBERLAND V ALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG, PA 17055 800.382.1436 ( I \'L \t'2.1.... I ,..\l ~ 641 7 8 0 , REPlACEMENT CAR NO 0AIG.~\ll.1 c;:: MAKE-MOOEL-YEAA-COLOA I-'~~ ~ '":) ~P: ""76=\(0 ODO~ETER i~^:dL ~A Cf90\ \ I ~ANx(rt: C l! ' .a/I~or""'\ - 5 Miles @ Hours @ E EDays @ \4 Y4 Weeks @ ADDII'\NAtAE'{'ERN~.A" 1\~~-PiHON N~-. O~TE.6~"JA! ~ ~ Months'@ Ll,\-L,..oo- 1'\\ '\ 1\ 'M \f' f..... ~ "'-4 TotalTimeandMileageCharges DRI ;l-' r:J.'tC.e~'\r\ STA UNTRY ~TION~ / _nF V'~ .'\--- \.." Il....~ / / - Gas (Taxable) ~. PHYSICAL DAMAGE WAIVER ~ PHYSICAL ;\!,BiU,ES ...-"l..(\C. r\..., I t::: ACCEPTS DAMAGE WAIVER X RATE $ \V"" U PER DAY $~ER WEEK x (NOT INSURANCE) By ~ Initials. I accept or decline PhYSIcal Damage WaIVer at the rates hsted above Sub-Total ~ It I decline to purchase the Waiver. I accept full responslbJ1JY for loss by colhslon or comprehen. Sales Tax or Surcharge . Slve damage, regardless of cause, up to $ I ('In ~ per occurrence, which may be Gas (Non.Taxabl~_.W 1// . a charged to my credit card shown below /"'""\ _ C/CDW (Non-Taxabfe) I Accepting reduces my responsibility to $ l.-) per occurrence, whIch may be I .-"1, charged to my credIt card shown below I ~ 1 PHYSICAL DAMAGE WAIVER IS NOT INSURANCE, U_ / rr I r ffI V 'S PERSONAL ACCIDENT INSURANCE (PAl) ~~ "",,--i~ilials, I accept or decline enrollment for Personal Accident ~ DECLINES Insuran8li!.... 11 I a~cept. I understand and acknowledge that cO\' is at the "~-JQfI.i<:atec;1 and that I have read the ~ate of ACCEPTS insurance furnish~eaJer prior to rental. x RATE $ PER PER WEEK X A~~SS ~ERSON ECTS COV~PEC) ~ By my Inlllal cept or decline enrollment fo~al Effects Cover a accept. I understand and aCknowledge th~rage DECLINES IS e rates Indicated and that I h\\Wa.read the certlflc~ ACCEPTS ..".. urance furnIshed by dealer prior to rEt(l;aT. ~ Sub.tolat $ ~ RATE $ PER DAY $ PER WEEK X "" ~ $ VEHI C rN~TI~ _ .- _ .. SPARE CUSTOMER _ $ OUT lI' '\ ~(\ ("'(Y;If"\/\ JACK 0.., INITIALS Less Deposits $ ~ - $ \L\fTl" $ (717),691-1880 ( 'e- ml' ""h\ \ " ().\.. ~ I c>f!.1 ~ .. ,_~PCOOE Ilf -!"". ~~ ""'':'''''\-r"rl HOME PHONE f'r,"'^h DA~~rC~SE-i~ uQ4 BIRTH ~~ I" ' SOCIAL SECURfTY NO. II"" ~'rl, , L~C~NTA<;; _ ,-,\- ..;:;., .F~DAESS :-l V"\f'if ('" \ \'\.. \ e.:--.w \\ EMPrt:' t\J t:\ LL I Y'\" q \()~O EM~^\\h ~O I\V~lP ~~rY\~h ~'- ~,1AE~...:l PHONE f will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 of the back of this agreement Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. If none, print NONE across this section. GAS OUT IN IN RENTALWD~5 DRC REJECflON Of UNINSURED MOTORIST PROTECTION AMEX I am rejecting uninsured motorist coverage under this rental or lease agreement. and any policy of insurance or self.insurance issued under this agreement.. for myself and all other passe,n- gers of this vehicle. Uninsured coverage protects me and other passengers in this vehicle for loss and damages suffered if injury is caused by the negligence of a driver who does not have any insurance to pay for losses and damages. cefDINEFlS VISA M1C R~nl.{. Q - ~ "" y-- ~ _ \ (\ Slgnatu~e. "'f"Vr\{: \1 - \ rrlME AMOIfrH I I OTHER LICENSE NUMBER ODOMETER IN ,. OOOMETER DUT MILES DRIVEN rn\~ ''"'\ .-.-- ..., '(' y, MILeS ALLOWED CHARGEABLE MILES (j) DATE DUE orlC EXPIRATION 0 "lV' .rlCY I 'C,,, $ $ $- $ $ $ ~XJ ~.1 , $ $ $ I , I I , ~Tl $ $ $ $ $ , ---'- .,. PERSO AL AC DENT INSURANCE $ I Sub-Tolal I $ , PERSONAL EFFECTS COVERAGE $ ....1';"'0, ~ I Net Amount Due Net Due Renter WARNING . I have read carefully all driving and use restrictions on the reverse side. . I am responsible for all traffic \/iolations and must turn in all summonses upon return of vehicle. . I will report all accidents immedia\ely. I have read both sides of this "greement and agree to its tertns and conditions. I authorize you to process a credit card 'llout:her. it any, in m'l name. I ~1S YOUR INVOICE. P?!~ ~UE ~ ~CE~T I I ~d)o I X 0(\mmaml {+ ({J-I{..JU'O -I)" RENTER'S SIGNATURE EXTENO TO ADDITIONAL CASH DEPOSIT , DATE INITIALS eXTEND TO ADDITIONAL CASH DEPOSIT . INITIALS DATE CREDIT AUTH NO I DATE CHECKEDOU~~ FINAL CHARGES ARE SUBJECT TO AUOtr-"" ~ CH~\s.. AUTHORIZED BY' ''''10'11''''1' ADAmsU (f<J;llllJ"'" CUMBERLAND V ALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG, PA 17055 (717)691-1880 800-382-1436t I')~\~'\\I ^ REPLACEMENT CAR NO. E E Il< " ADcrrtN7~\( rv ;nH'M\\~;J y.Z"'Rj .:.: D ~ L7"'Y" r S'ATEICOUN"'" DATE . F" F -...i'-- ~\ r ....1-- / / - Gas (Taxable) ~:.'.l~' ASYSICAL DAMAG9JAIVER :;s PHYSICAL D~Y' ES J!ZI I 'S ACCEPTS DAMAGE WAIVER ;)( RATE S V. PER DAY S '.IJ) ER WEEK x (NOT INSURANCE) By my initials, I accept or decline Physical Damage Waiver at the rales listed above. Sub-Total If I decline to purchase the Waiver, t accept full responsibility 10r loss by collision or comprehen- Sales Tax Of SUrcharge sive damage. regardless of cause, up to $ ,r-:.3~ per occurrence. which may be Gas (Non-Taxable) charge~ to my credit card sho~n. ~eIOw. _ . C/CDW (Non-Taxable) Accepting reduces my responsibility to $ - per occurrence, which may be I ' J......"..... charged fo my credit card shown below. f J-.r~ PHYSICAL OAMAGE WAIVER IS NOT INSURANCE, r..J- 00 l v..-.. l., t'l'l'" ,t-"1-.. IN " PERSONAL ACCIDENT INSURANCE (PAl) l::="" .f. ' By . itials, I accept or decline enrollment tOf Personal Acc~ PERSONAL ACCIDENT DECLINES Insurance. _ ceeDl, ~understand and aeknowled e th rage ACCEPTS INSURANCE IS at Ihe rales ~ed and thai I have read rtificate of insurance furnished by er prior to rent I Sub-Total aATE$ PEn ~ERWEEK X I PEASO FECTS COVE (PEC) . ~~6 By my inili ,accePt or decline enrollment for sonal Effects PERSONAL EFFECTS DECLINES Cover . I accept, I understand and acknowledge coverage ACCEPTS COVERAGE IS e rates indicated and that f haye lead tlle ce . te of --"'" surance furnished by dealer prior to re~~~ .......... I Sub-1otal ~ RATE $ PER DAY $ PER WEEK X............... ~ VEHRI\C~Nq ... I>.. h. SPARE CUSTOMER _ OUTI ""\D ~ ""( ").{ >JI JACK O.K. INITIALS Less Deposits o I am rejecting uninsured motorist coverage under ,this rental or lease agreement, and any policy of insurance or' .elf-insura~ce issued under this agreement, for myseH and all 'other pusan- gers of this vehicleo Uninsured cover.ge protects me and other passengers in this vehicle for loss and damages suffered if injury is caused by the negligence of a driver who does not have any insurance to pay for 10sl8l and damages. o ~ ~~~::~. If. ~y w bDJ. j..1IME I ~ffOur~T AUTHORIZED BY. CHEC~OUT B I' ,,-,,1' FINAL CHARGES ARE SUBJECT TO Auull ,---", .""~"-~ RENTAL "AGREEMENT - ~ -.~" - ( R r -..J.NTJ. ~I ,,,",,", ,\ ""'~' .IIIIVlI I Yli~~ , I HI n, '11"'\ \ HOM"""""RESS _ "" ., _.~ "I '. n.iO i--lL.J~ f-I 0 . ~(' 1 T \1. 1t-- I'Cr I C'TY "- ,. r--.~ATE 'f ,.-,,,c:..e'PCODE I J \IllY'.. YI-\ IUL~, DA'~"SjJpE~ NO. ,J /\ I I RT}-.. ....... .... "."P~ C'V, ....~-~ " II 1--\4 t-JH .. r.-:-'\I-( f ) !!!!!j I~ A b 0- SOCIAL SECUA,ITY NO,. HOME PHONE LO~ONTA';; Y \,1"'0 l/l ~AESS . t', I'V ''rn;-'- '..l.."- P - t 1 0.1\ ~\f)')Lr-r'i'O~...... y.--..,) ""rF\!:\A(iREl{[< +h \..J:\ (' Q ~V 1JJ lP lOr r~. _, ~/'> -'\: :) STATE \ 'Ff /l ~~~ED BY ,r.. - ( U\('l, 'I t t .. "1\ ~, ,r \ 'V' ./OJ "'q'C)...... GAS OUT IN PHONE I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibiled_ If none. print NONE across fhis sectIon. X RENTER"S INITlAl.S IN RENTAL Wll.l BE PAID BY '1 D6)5 DRC REJECTION OF UNINSURED MOTORIST PROTECrlON AMEX CBIDINERS VISA Mle OTHER f , CREDIT AUTH NO I~- I c'" ""4'1' ADAmSD (1CIl11)2.o'" .1 ~I IfiIiilJll;lI.1_li!liIllii[H..lllWlli:!.'j\%:i!"i,t~~" ~ "." - 642002 ODOMETER IN NUl A MlJbE\S~ L~"";..NUMBEA " . Z...!-.....:i c'\-f( ^ ODO::?ER , I" q6Lt- OOOMETEIl '""-Jt^ . n':' T'EN -o"(A,,~~ ~ DATE_ _-t.. t: "l ~ -::2..,;' A~ r:: ~ DATE DUE '- ~ Et'RA111.~, MAKE.MODEl-YEAR-C:OLOR LICENSE NUMBER ODOMETER OUT MILES DRIVEN t'J.~foo MILES Al.LOWell Ct-lARGEABlE MILES Miles @ Hours @ Days @ Weeks @ Months \ @ Total Time and Mileage Charges C $ , $ , $ . $ , $ rY'1 $ 0\ rI. FJ '-"'/'"0. $ . $ $ $ $ ~ I , , $ , --.- ""'...........: $ '-'{",."J 'f $ V,7C..! $ .... '-'i $ , .-l--- UJ 1'1: ..... - , , $ , I , $ , I , $ , , , , $ ~ $. '^- t(.$ II J J7''J'l'7\ oJ $ , Net Amount Due $ $ Net Due Renter WARNING . I have read carefully aU driving and use restrictions on the reverse side. . I am responsible tor all traltic violations and must turn in all summonses upon return of vehicle. . I will report aU accidents immediately. I have read both sides of this agreement and agree 10 its terms and conditions. f authorize you to process a credit card voucher, if any. in my name. ~ YOUR INVOICE. P ~ENT OUE ON RECEIPT --......:.. ~ "'^ ( i ~,\ ., I_/'^..-t"\", .x_ lU1 '\~ \'(INX(( RENTER'S SIGNATURE ADDITIONAl. CASH DEPOSIT $ EXTEND TO DATE INITIALS EXTEND TO ADDITIONAL CASH DEPOSIT $ INITIALS DATE I ;)\~ - CHECKED IN BY CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717) 691-1880 800-382-1436 \N\L.. \~'I.T\1O ' - _ REPLACEMENT CAR NO. o~ b '\. MA.KE.MOOEV(EAA-CQlOA M "'\ h \ 5 \-6...... c.. LIC~~ NUMBW . 'Q /' ~r _r" lDl.llD OOO~ETER r,)p 1 \ "f\ 'lfA a.f11i E E 14 14 A'o:,\\RCR(A;C,.\\ ~\ ~P'(\7~'\\l ;TE~Bli : ~ DRIVER'S LIC~~ ~MeER r tV, j STATE/COUNTRV EXPIRA:/TlONOA ITE 1([: F U \S" I Gas (Taxable) ~ PHYSICAL DAMAGE WAIVER ~8 PHYSICAL :!Slf\.'S RATE $ \ '0 ~S PER DAY $ ~ PER WEEK X ACCEPTS ~~~~~~u~~:rg~) By nJy initials, I accepl Of decline Physical Damage Waiver at the rates listed above. Sub-Total If I d cline 10 purchase the Waiver I accept full responsibility for toss by collision or comprehen- Sales Tax or Surchar~ slve damage, regardless of cause, Ufo to $ --.Jrrf:!(> per occurrence, which may be Gas (Non-Taxable) ~^ charged to my credll card shown be ow. _ C/CDW (Non-Taxable) ....." Acceptmg reduces my responSibility to $ 6 - per occurrence. whICh may be I charged to my credIt card shown below I PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. l.::h~ '\ I JR{ , "t-FN.. .- ~~s PERSONAL ACCIDENT INSURANCE (PAl) i ~ -./ I I --............ By my initials. I accept or decljne enrollment for Personal Accident ~ PERSONAL ACCIDENT $ : DECLINES ranee. If I accept. I understand and acknowledge that cover ACCEPTS INSURANCE I is a rates indicated and that I have read the ce~e of I insuranc ished by dealer prior to rental. I Sub.. Total $: x RATE$ ~ PERWEEK x I I "=~~S By my ini~~~~~~~~~~sona\ Eflec\s A':~'" PERSONAL EFFECTS $ ( oeCL NES Co~f I accept. I understand and acknOwl~~at cover<1ge ACCEPTS COVERAGE 1 ~I ~ at _~~ rates mdicated and that I hSje.Jead the e of t Insurance furnished by dealer pnor to ref1~ar. -......~ I Sub~fotal $ I - RAT~$ PER DAY $ PERWEEKlx -~$, ,~.-- VEHICLECONDfTlON\) SPARE CUSTOMER _$ \U J r 111~ I OUT ~ ~ a'f ''''' ~ JACK O,K. INITIALS less DepOSits $ 1 I.J -'-, . - I . =,,-,= -"'._~~ - ~..... RENTA'L AGREEMENT ( ~,1, dl HOME ~{J.e' A. CITY 11\,- ._ZlP In.~,l; l....~'~ " ""l \.t y~ HOME PHONE RE fJ\c.t\, Mu\.,'n '/ u~..... ,....l.. f'.c'." sr'Y" ~ STAT~U " DRWI 's~E~-ll(;"Ur B '/3 J: 0 SOClAl SECUArTY NO. L~ CONTACT .. '\. \ ADDRESS h\-- ~C' (" \ 1\ IALol"e\ (:"K"A - L c\\o l.\SB n;~,~~ EM\n~l{'DRi\1.' Lc.. \\ e. f'",\\~ tve. c(n.('U\\ct".CA ~;~ 1\)(. blF~~::lc PHONE I witt not under any circumstances surrender the use of the rented vehicle to any person other than those listed below 01 in Paragraph 6 of the back of this agreemen!. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. If none, print NONE across this '5Bclion. GAS OUT IN IN RENTAL WILL BE PAlO BY ID~5"" ORe REJECrlON OF UNINSURED MOTORIST PROTECTION AMEX I am reieeting uninsured motorist coverage uncl.r this 'rental" or lease agreement, and IIny policy of insurance or lelf..insul'llnce jssued under this agreement, lor my.elf and .n oth.r panen- gars of this 'Vehicle. Uninsured coverage proted' me and other passengers in this vehicle for Iou IInd damages sullered if injury is caused by tb. negligence of II driver who does not have any insurance to pay for 10.... and dlmlge.. CB/DINERS VISA MIC r~ 1'\ _ ~~~;:;e Yl \ c.. ""' 01\\ I- \ ~I ...... I OTHeR CREDIT AUTH, NO AMoum AUTHORIZED BY: ~'" _~....l " ,~._-~ ll" "~'~~~~,,,,,*."'.__i.~~.ir<'_. 642227 LICENSE NUMBER ODOMETER IN , ODOMETeR OUT ODOMeTER OUT O~ND.~IM N,.. r. \., "'l: ,~/\{J r\~ C!i4. '" $ ~ ^~,",\' MI\..ES DRIVEN \ ( \. I)C:;' \""\~: / ....... - MILES ALLOWED . CHARGEABLE MILES / .... DAlE DOE RAOON OF AG ME Miles @ Hours @ Days @ Weeks @ Months \ @ Total Time and MUeage Charges ~ $ I $ , $ I $ , $<'\",,", e:n $ "'I ',.,l \,- f?r) $ I $ I , I , , , $ ~,.,l,'" r}n $ F-. -'<&',../1.-, $ I $ I -- $ $ $ $ Net Amount Due $ $ Net Due Renter WARNING . I have read carefuUy all driving and use restrictions on the reverse side. . I am responsible tor all traflic violations and must tum in all summonses upon return of vehicle. . I will report all accidents immediately. I have read both sides 01 this agreement and agree to its terms and conditions. I authorize you to process a credit card voucher. it any. in my name. THIS IS YOUR INVOICE. PAYMENT DUE ON RECEIPT \ ,~r~'\.~-""'" AENTEFrS SIGNATURE ADOITIONAI. CASH DEPOSIT $ - ".. x "-o.J EXTEND TO INITIALS DATE EXTEND TO DATE INITIAL.S ADDITIONAL. CASH DEPOSIT $ CHECKED IN BY I DATE C~~y: FINAL CHARGES ARE SUBJECT TO AUDIT f"'I"'''''I' ADAmSD 18:ll)m...,,, .......- .. ~.. ~=,. =~...d~""~'L'5,_"""""',."'"i< ~ .J UMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717) 691.1880 800-382-143\,N \L.. \ :::6'1'\ G, . .:'.' . REPLACEMENT CAR NO. ORIG /':1 - "'tn"'\",~' , ~ '"",L~'~ 1~\51 ,~ "Z'r N':'~ 16"\ C RENTAL, AGREEMENT :"~'?'\'6, r~",,~\~ t-\iJ\Oh" ~~'-l' \ \D~" {'ld!.. ' CITYf\I\ e,J" \ STAr> T DRN '1rti I I STA L A '} ,;,j l,D,"1 r J Il IllIIl1" D~ t:.cz SOCIAl SECURITY NO. r I;' JVA../ ',' '" L~ CONTAC~T........... ~"\ br \ ADDRESS '- L \\ \ !\Jr;;,,:n ~ EMf-rYN f.\- - L"'i'.-)h O\\Ol\-56.:oQ5~ E\0~qDro l'-c< \~ e p~\ \~ ~ ue . F.J:rc\\C"tI r, ~TA~ t\)t: ;:},f;tt~ , PHONE I will not under any circumstances surrender the use of the rented vehicle to any person other than thOse listed below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by. any driver In violation of Paragraph 6 is prohibited. If none. print NONE across this section. X flEHTER'S IHlnALS RATE $ DRC REJECTION Of UNINSURED MorORIST PROTECTION AMEX I em rejecting uninsured motorist coyerege IInder this rentel or Inse .g....ment, .nd eny pDlicy of insurence or lelf.insurance issued under this egreement, for myself end ell other pBSlen- gen of this vehicle. Uninsured coverage protects me end other passengers in this vehicle for 1011 end Jamages suffered if iniury is caused bV the negUgenett of . driyer who does not have any insurance to pay for 10118I end demages. CBfDINERS VISA MIC OTHER ~~':::;~~ 5 ) V<. 'nm \=~ \~ I I CREDIT AUTH, NO I DATE liME AMOUNT I AUTHORIZED BY' THIS IS YOUllINVOICE. PAYMENT DUE ON RECEIPT x5\~6.nCor. ~\- Gt.1034 0 RENTER'S SIGNATURE ADDITIONAL CASH DEPOSIT $ MAKE.MODEL-YEAR-COLOR LICENSE NUMBER ODOMETER IN ODOMETER IN EXTEND TO EXTEND TO ADDITIONAL CASH DEPOSIT $ CHECK ~ ---. 1 )" I CHECK , ,C i:'P"~IT FINAL CHARGES ARE SUBJECT TO AUDIT (m) ",'-om ADAms II (alIl) In;)''' 642551 - ~~II 2.J,qt ,- , , , , , "1K DATE INITIALS DATE INITIALS ".-...... ..t I r-T' ~"" CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717) 691-1880 800,382-1436 OA""LS\~ 1 ~ ~KE~a\~ L~~IlEA _ ""L l3C\C\ ~ETEA \ S -\L:i '3 OA EAN~'n~ ~ ~ , I"1T '~ III ~/u.:r,\C..:).,. AlIlI ~HARGEABLE '~~~. DUEEEME.k.J MilES . " '-0. - .-; GAS ' OUT IN Miles @ e '$ - 1 Hours@ $ $ I E E Days @ $ $ I "V4Weeks@ $ $ I AOO~~ RE",:R ~AM~ \ ",0, ",*"ME ~~ ~~. DATE 0; Bllm~ ~ Y, Months I @ ~ $ "1',.,[~ Ot"} 0\" 0 r D\\ \' \f( ID\'\" .... I I IJt '!4 TolalTimeandMileageCharges $ CI~T ~ ORIVER'SUCENSSAI(l~ER GN 51ATEICOUNTRY _~"':TE Ie (!) $ I 0(- J) ~ I I . Gas (Taxable) $ ~ ~~s PHYSICAL DAMAGE WAIVER ~ PHYSICAL : o~S ' \":1.. C15 0. , /: ,;:- ACCEPTS DAMAGE WAIVER $ I X f\. RATE $ '::'..r \ PERDAY$~PERWEEK x (NOT INSURANCE) : By my initials. I accept or decline Physical Damage Waiver at the rates listed above. Sub-Total ~ _ $ q ~ .~- I ", I decline to purchase the Waiver. I accept full responjpyily for loss by collision or comprehen- Sales Tax or Surchar e V / /A $ Y"\~. ;.J ~' slve damage. regardless of cause, up to $ /Cl)v /~ per occurrence, which may be Gas (Non-Taxable) _ #oj' /.//1/ $ I charged 10 my credil card shown below. C/CDW (Non.Taxable .. /"l $ Accepting reduces my responsibility to $ --c,....- per occurrence, which may be I I charged to my credit card shown below. I.... ~ :~~ .!.- PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. I -J '11' I :zz:. ' M " ...-- ~ PERSONAL ACCIDENT INSURANCE (PAl) ~..;.v 'J t7 , , R"'~ By my initials, I accept or decline enrollment for Personal Accident ~- PERSONAL ACCIDENT $ I DECLINES ranee. If I accept, I understat'ld and aCk;~nOWledge that covera ACCEPTS INSURANCE 1 is a rates rndicated and that I have read the certifi of : insurance . hed by dealer prior to rental. I Sub-Total $ I RATE $ ~AY $ PER WEEK x I I PERSONAL EFFEC VERAGE (PEC) R~" I By my initials, I acce~cllf\e ema for Personal Effects 'PERSONAL EFFECTS $ 1 Covergae. If l-a~ understand and aCkn~e that coverage COVERAGE I DECLINES is at Ine ~dicated and thai I h",ve read I rtificate of ACCEPTS I ~urnished by dealer prior to r~t#l. sub~fotal $: X ~ RATE $ PER DAY $ l' PEA WEEK tx-----.. Less Refund For: $ \ _ ..- f"Q"l:HIClE CONDITI'f SPARE CUSTOMER $ I (~ ~ "P") OUT V-V, ' -, 0. tAt:: JACK O.K. INITIALS Less Deposits $, L--.- ~ P Net Amount Due $ IN ...J-. IT I......... : RENTAL WILL BE PAtD BY IJOQF" RENT AI: AGREEMENT . ( RENT PRIN1\) , , 1\ - i'I .1T \ L\ I . Y\ Lot l""'ler ." , l..to! '''llf\b HOM~~c; F::_",; _'." ~ . CITY.~-~, " if ,l..... _ 513 A -,r'l'::;" ZIPCOOE ORIVOO~\\-U\'~ STAtA " -~~;J BfTH il~ \ SOCIAL SECUR.lTY NO, . HOME PHONE ~L CONTAC! --r::- _ \" AD RE;.". ,.., ~;::<O E C7~("(":" J\~/ C\ ",\"1P:,esOSa.;l ''-I:t'\t\ EMr)"t 1"\\"\ 1\" _.::\ oJ ' Pf.'hr T EMP ,O!~R" '~ESS ., I D L II L.l.1 1\1 _ L-C.. ~c:: I Olr" \lC. C'?::.o.n:.-\\'<'UI .rL ST~i""- /~ e-" -;: ~~ ~ J WIll not under any circumstances surrender the LIse of the rented vehicle to any person other than those listed below or in Paragraph 6 of the back of this agreement. Operation of Ihe vehicle by any driver In violation of Paragraph 6 is prohibited. If none, print NONE across this section, X RENTER'S INItiALS ORC REJECTION OF UNINSURED MOTORIST PROTECTION AMEX J am reiecting unin.ured motorist covel1lge under this ,rental or lease agreem.ent. and any policy of insurance or "If-,in!~uranc. issued under this agreement, for myself and .u oth.~ passen- ger. of this vehicle. Uninsured coverage protects me anCl other passenger. in this vehicle for lols and damages .uffered if lniury is caused by the negligence of II drive, who does not have any insurance to pay for 105181 and damage.. C8/DlNERS VISA. MIC , F;;k Renter's .,.:" Signalur.,e:::." ""'1"'\0-. \ ':/Date f f OTHER CREDIT AUTH NO DATE TIME -I AMOUNT AUTHORIZED BY: '- ., ~.~. .......~.....,...........,~~~.....,;, 64'1362 REPLACEMENT CAR NO. MAKE-MODEL.YEAR-COLOR LICENSE NUMBER '> ODOMETER IN ODOMETER IN ODOMETER OUT MILES DRIVEN {){kj \ .'-"" , MILES ALLOWED $ Net Due Renter WARNING . I have read carefully all driving and use restrictions on the reverse side. . I am fesponsible lor all <<attic violations and mUSl tufO in all summonses upon (etum of vehicle. . I will report alt accidents immediately. I have read bolh sides of this agreement and agree 10 its terms and pondilions. I authorize you to process a credit card voucher, if any, in my name, tHIS 1$ YOUR INVOICE" PAYMENT DUE ON RECEIPT X ~'v.nc... ~i\e. ("I.\-\\Oq '-.J RENTER'S SIGNATURE EXTEND TO ADDITION~L CASH DEPOSIT $ INITIALS DATE EXTEND TO ADDITIONAL CASH DEPOSIT S INITIALS DATE ~EO~Y BY, ~\" 1""""''''1' ADAmSU (1al11Jl..,.. FINAL CHARGES ARE SUBJECT TO AUDIT ~ ,I ' ~UIVI~ERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717) 691-1880 800-382-1436 ~ ,liI,ji~",ti......,....,. D\J::5 115'//\ E E 14 14 ADO..:r.:.O~AENTEA NAME,. 0:_-'1 HO", PHot'E NO. -.L DATWrBIRTHj \!I 1-2 '-'\ \\ 0 \..A \\~Ol eX. (" ,,~.,.. ~ ~ 'Ii DRIVER'S L1CENSE'7lMBIj{l) I A STATE/COUNTAY EXPfRA~ ~TE <!.... lfF- for I\... / I - Gas (Taxable) ~: PHYSICAL DAMAGE WAIVER ~'I PHYSICAL DElOU'es "2. c.... C' ACCEPTS DAMAGE WAIVER x " RATE $ \.;J --I :; PER DAY $ ~ PER WEEK x (NOT INSURANCE) By my initials, I accept or decline Physical Damage Waiver al the rates listed above. Sub-Total If I decline to purchase the Wail/et.1 accept fu~;r~~~lity for loss by collision or compcehen- Sales Tax or Surcharge n '-'/0 sive damage, regardless of cause, up 10 $ I'(L) u / () per occurrence, which may be Gas (Non-TaxableIA nl" J ad / charged 10 my credit card shown berow. _ C/CDW (N -T a"'-I&)' ..., . Accepting reduces my responsibility to $ c:-~ - per occurrence, which may be on ax......,,,! - charged to my credit card shown below. - I , "\ t:It PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. I At' /)/ J ,yo o...,lL .~~. PERSONAL ACCIDENT INSURANCE (PAl) ~' '.v / ............... By my ini!ials, I accept or decline enrOI'~enl for Personal Acci PERSONAL ACCIDENT OECUNES nee. If I accept. I understand and acknowledge tha rage .""'''''PTS INSURANCE is at . dicated and that I have read th rtiticate ot ~ insurance furnishe aler prior to rental. I Sub- TDtal RATE $ PER D PER WEEK x I PERSONAL~TS COVER~EC) ~ By my InitialS. I ~or decline enrollment for ~Effects ~ Cover ae. If apt, I understand and acknowledge that9_~~ DECLINES IS at t as mdicated and that I have read the certlflcale"l7fo, ,EPTS I nee furmshed by dealer prlor to rewa~ ~ I Sub.Tf;Jtal $ ~ RATE$ PER DAY $ " PER WEEK X ~$ "_ VEHtCLECONDITION _\'\ . ,A - SPARE CUSTOMER _$ \r-T })-'\\~n OUT 1"""10 CJI<.. - c. c...r , JACK D.K, 'NITIALS Less DepOSits $, ~ rY\~ -"~_.,.."'~"_.".. . , RENT AI., AGREEMENT ~- ~""","N ( 'Ie"11"l !-4)......I\ .n . __n, AI. ,\I' , .... \...~C' \ '\4\ {"Y" rH'\I I.: ::> HOMe ~ReSS r 66:~0(~. c;.-"'-c...~\Uc. CITY l2. \ LJ "-J STATeA ,I": Z1Pcooe "-h.~ \ --au"c.. r rr ,Orrr-. -DCS:JO DAIC:05~\.\-V'i3 STATeL A- '-'l'~~ BI,\H ~1 {;, \ SOCIAL secUI\ITY NO. 'r' L CO~:A:'~e /\)~er I c1\Os - L\a3 -,_.-..c. i't\ 'tW) ')lPIOyeR '" A_ \ .' ..... PHONe (T' - n IVCl:::JT(.(" t ~~c... '~rc... eMi;OY~'~~DD~E,SS L \' v.. 'I A ,0",,,, IV. ",')e. c,r...... 111)::::. ~Y-""'\i('l~ &:.o~ /flc. - ~E"rt~9 HOME PKONE I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by any dril/er In violation ot Paragrapl'1 6 is prohibited. If none, print NONE across this section. GAS OUT IN X RENTER'S """"" IN RENTAL WILL BE PAID BY I O{). ,- ORC REJECTION OF UNINSURED MOTORIST PROTECTION AMEX I am rejecting uninsured motorist coverage under this rental or lease agreentenf, and any policy of insurance, or ,..If.insurance issued under thi, agreement, for myself and ,11 other ,passen- gers of this vehicle. Uninsured coverage protect' me and other passengers in this vehicle for Iou and damages suHered if iniury is cau5ed by the negligence of . driver who does not have any insurance to pay for loues and clamas.s. C810lNEAS VISA MIC OTHER Renter's 6 )~""' r _ r \6 Signature H '\..,..I}r ( \;...0' I DATE TIME I AMourn AUTHOFUZEO BY' I I Date CREDIT AUTH NO REPLACEMENT CAR NO. MAKE.MOOEL-YEAR.(;OLOR liCENSE NUMBER ODOMETER !\Y?tQ8 'N ODOMETER OUT MILES \qCoGj DRIVEN MlLI!S ,...., AlLOWeD ., CHARGEABLE /' MILES - -. Miles '@ Hours @ $ Days @ $ Weeks @ $ Months \ @ ~ ' Total Time and Mileage Charges PERSONAL EFFECTS COVERAGE Net Amount Due - ." "'W_-"-"-,"M<o;,,,,-""'~"'"~ 641534 OR'h'~ 2/ L',D \~o L ~~B~SC\~ ODOMETER ~ O~~R '\1~-'\9 ~N~ ''Me., Ltl r;:;; DA .No~1tq 4-1 RA DATe ~Ree ~} e $ $ $ $ $ $ $ $ , ~O'""> , , I , , , $ ""I~r'Y"~ $ ~..... $ $ $ I ......, - $ I , , , , : , $ $ $ $ Net Due Renter WARNING . I have read care1ully all driving and use restrictions on the reverse side. . I am responsible for all traffic violations and must turn in aU summonses upon return ot vehicle. . I will report all accidents immediately. I have read both sides of this agreement and agree to its terms and conditions. I authorize you to process a credit card voucher, if any. in my name. -';r XM'" . '-l EXTEND TO THIS IS YOUR INVOICE. PAYMENr OUE ON RECEIPT 'n,c.\- (011-\\ 0<; . INITIALS RENTER'S SIGNATURE ADDITIONAL CASH DEPOSIT $ EXTEND TO ADDITIONAL CASH oepOSIT . CHECKED OUT BY: CPr,'IT FINAL CHARGES ARE SUBJECT TO AUDIT !"fl~'''''P ADAmsD ltoOlm",,,' DATE DATE INITIALS Y I~"\ AEN~ IPR"fi ,.' _ .c> ~_J ~CIi ~. . po..." , . .-. ~ " ,--.... ., "_Rol!!II"'_"''-:_~''~''''-'-'' CU~;RL~~"D'~ALLEY MOTORS ~ K 6720 Carlisle Pike ~\l'......) MECHANICSBURG. PA 17055 (717),691-18~0 800-382-1436 . 64 '1690 1~4"'5 l. ~~,\' \c:::. \~ LICENSE NUMBER . ~N~MBER ~~. t) ODO~ETEA ~J.\50 OOO~ETEA G: ~ETEA \'\cu.-1 Q/~;;' D?-;~Elr\q,,"~ MIlES :-. . ~",ANO 'liME - \! AlLOWED II. ~ 1\ T ..., ,/~{ A , ~I / DATEOUE' ~HARGEABLE EXPIAATIONQFA MilES . , , GAS OUT IN Miles @ It: $ I Hours@ $ $ , Oays@ $ $ , Weeks @ So -. I Months \ @ ..J j Vl "/1:: r,;'.... Total Time and Mileage Charges $ G.o\ .-I ') rcY'"", $ I $ I , , , I , E E \4 V. AnltAr~^':~(\(\ 0,'.1 r ONE~;._", OA;;J,Wli :: ORWEA'SlIC'1ENSE~~~ ~ STATE/1:OU y EXPIAA!"",DA!E~!, F (.-1 f\. r Q.. / / __ Gas (Taxable) ~ -, PHYSICAL DAMAGE WAIVER ~. PHYSICAL o S 1'\ ^ / r ACCEPTS DAMAGE WAIVER X RATB \ ~ ':1~ PER DAY $"11.U!u PER WEEK X (NOT INSURANCE) ~initic~. I accept or decline Physical Damage Waiver at the rates listed above. Sub-Total ~ If~Gti 10 purchase the Waiver, I accept full resPOnSibj~ty for loss by collision or comprehen- Sales Tax or Surcharge ~ sive damage, regardless of cause, up to $ \ ~ % per occurrence, which may be Gas (Non-Taxablel!Z..1:=iO r'P-rA \. charged to my credit card shown below. ~ C/CDW (Non-Taxable) Accepting reduces my responsibility to $ --- '--/ - per occurrence, which may be r ~ charged to my credit card shown below. I L.-'.3 PHYSICAL DAMAGE WAIVER IS NOT INSURANCE, Q..OO 1.1.." YT A-I- T . "It "" " PERSONAL ACCIDENT INSURANCE (PAil ~ I Itrals, I accept or decline enrollmenl for Personal ACCident ~ PERSONAL ACCIDENT DECLINES Insuranc i:' t, I understand and aCknowledge that covera ACCEPTS INSURANCE IS at the rates In and that I have read the cert~ of insurance furnished by de r to rental. X RATE $ PER DAV PER WEEK X '::~~& ~PERSON TS COVERAGE (PE~ 'mm~" By my initial ccept or decline enrollment for Persona~ DECLINES Cover . accept, I understand and acknowledge that coverage is e rates indicaled and lhat I h~~fead (he certificate of .-/ surance furnished by dealer prior to rEfCl~ci'f. ~ RATE $ PER DAY $ PER WEEK VEHICI\.~~~ _ .. SPARE OUT I ~ '" JACK O.K. ~ ~""-~"'~''"..'~''- RENTAL AGREE'MENT - ,..r\' II"'h~'rR - 1'"'>. I ( HOME A~~ _ _ ~ Y'i"v'\ r I. CiTY......... r"'\'~ "\ -STAre ',"" -<'Il<'AI -'VI..... L.:i;:" D~VER'S UC~E~'~ cJ Jifif"h 8'rH in fA \ SOCIAL SECURrTV NO. ~AL CONTACT , ~ \ """ ,~ , P'i~~E:IS ..- ..... , I' .~.. ~ ~~\A EMPL "~;~E~\. ~J::::n t.V ,/y l.. . _I ~ .sr.~T~... -"Zi'\.,,' "NT ,"Yl~f''I ~'_ I will not under any CirCUm$t~es surrender the use of the rented vehicle to any person other than Ihose listed below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver In violatiOn of Paragraph 6 is prohibited. If none. print NONE across this section. - ..}IP CODE ~ . .~' OA'!... \-I'''~ HOME PHONE PH TONE _ .'~ 1."11 PHONE <:.::> Reo BY ~ X CUSTOMER INITIALS IN RENTAL WILL BE PAID BY I^'~ '6 DAC REJECTION OF UNINSURED MOTORIST PROTECTION AMEX I am rejecting uninsured motorist C:O"Ierlg8 under this r.ntal or lease .greement~ .nd any policy of insu,ance or self-insurance issued under this .greement~ for myself and .n other paSlen- gers of this vehicle. Uninsured COVtuage protects me and other passengers in this vehicle for lad and dam.,e. lufhuecl if injury is caused by the negliSlence of III drive, who does not have any insurance to pay for lossel and damages. ~ ~'n M~W~ I 10ATE ~E TAM~ fn AUTHORIZeO BY: CB/DINERS VISA M/C OTHER f CP,EOli AUiH NO REPLACEMENT CAR NO. MAKE-MOOEL-YEAR-CQLOR ODOMETER OUT MilES DRIVEN $ $ Q :cY"::> $ c::;.,~I~'::;- $ $ $ I Sub.Total r $ , PERSONAL EFFECTS COVERAGE , \ , , , , $ Sub-:l'otal Less Deposits $ $ $ H $ $ u..>-, I , , \ Net Amount Due $ Net Due Renter WARNING . I have reCld carelully all driving and use restrictions on the reverse side. . I am responsible for all traffic violations and muslturn in all summonses upon return of vehicle. . I will report all accidenls immediately. I have read both sides of this agreement and agree to its terms and conditions. I authorize you to process a credit card voucher, if any, in my name. THIS IS YOUR INVOICE. PAYMENT DUE ON RECEIPT - ~.J.. uU I i O-...C: RENTER'S SIGNATURE ADDITIONAl. CASH DEPOSIT . I~ r EXTEND TO DATE INITIALS EXTEND TO ADDITIONAL CASH DEPOSIT . INITIALS DATE CHECKED OUT BY. CHECKED IN BY ''''I'''''~n' ADAm5D (fOO,l]H'" FINAL CHARGES ARE SUBJECT TO AUDIT T~~"~'. RENTAL AGREEMENT -~~~ ~ .~"'-........... .- "_J... .~~ .0 = ", -"",;o];~~",,~!":lll,_~,~..;:;,~Ji, CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG. PA 17055 (717)691-1880 800-382-1436 , , E E 10\ Vi AOf'lTI~" L R'l"fR N"'~ ('"' _ .l\ @~~ ~ DATE,2i 81~ \02 Yo t..-t\' CVlJ~\\ k)n\M-Ukf- I % Vi DRIVER'S ICENSE ~...8EER AJ A STATE/COONTRY EXPIRA~ ~1E 1([: F { T 1\ rr / / - Gas (Taxable) ~ PHYSICAL DAMAGE WAIVER _ ~ PHYSICAL OEC~S ?"'l C. (""'" C. -, f..l-. ACCEPlS DAMAGE WAIVER X I' RATE $ \ -...J' \:7 PER DAY $ ~ PER WEEK X (NOT INSURANCE) By/my initials, I accept or decline Physical Damage Waiver at the rales listed above. Sub.Total A If~ decline to purchase the Waiver, r accepl fU"J:Sjl?n~~ for loss by collision or comprehen- Sales Tax or Surcharge '/4' sive damage. regar~less of cause, up to $ ~ V / ~ per occurrence, which may be Gas (NOn~TaXable)~ . hI', charged to.my credit card shown below. C/CDW (N n-T )Cab -../..." Accepting reduces my responsibility to $ -r.> - per occurrence, which may be 0 a charged to my credit card shown below. I AfI"f~' J 0 PHYSICAL DAMAGE WAIVER IS NOT INSURANCE_ L.i" 1'/1') . 77r '/ I~'lli' PERSONAL ACCIDENT INSURANCE (PAl) I V I I -----... By my initials, I accept or decline enrollment for ~~~sonal Ac.ciQe1Tf PERSONAL ACCIDENT ceo If I accept. I understand and acknowledue ~erage INSURANCE DECLINES is at Itl~ indicaled and that I have read certificate of ACCEPTS insurance furnlS dealer prior to rent ... REN~ ~ .(?)e("n<'t2 \^ cA\J .\ ~~.. HOME~~W r_r-." rC-65 ~ )\\X. . CITY(.J... \ C\ .~ATEf I ____ ZlPCOOE \:J~I""r\ """U,,"'e:.L-f+ IDI""Y~ OR\V~,;~~S~t!!1:... ~-"L V sr,AlE A \ -tX",OA'n , (E")..., ",r')l1l'7'\ J l- - \ l-t")rJ.. BIF.THj\E,c, \ SOCIALSECUR.lTYNO. HOME PHONE bL~ON::CTr i 1\) Po. . \l \ AotSiE\D' u::-c., -6_ti5~ L ".." EMPLl:j.R.N A PHONE, EM\LO~21D^" k \\~ f>~("~ CU\O\~ ~f::TC r..ft ~ ... ~ ~'r~~~E.- I will nol under any circumstances surrender the use of the rented vehicle to any person other than those listed below or In Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver In violation of Paragraptl 6 is prohibited. If none, print NONE acrOSS this section. GAS OUT IN X RENTER.S INITlAlS REJECTION OF UNINSURED MOTORIST PROTECTION AMEX I am rejetting uninsured Iftotarin coverage under this rental, or lease agreement~ and any policy of insurance or ..If~insurance issued under this agreement. for myself and 811 other, pasS:~n. gers of this vehicle. Uninsured coverage protects me and other passeng81'S in this vehicle for loss and damages suffered: if injury is caused by the negligence of a driver who does not have any insurance to pay for losses and damages. CB/DINERS VISA MiC ~::;::iu~. So, t \r\On \='S,. \. f f OTHER CREDIT AUTH NO I DATE I AMour~T I AUTHORIZED BY:. IME 64'1888 REPLACEMENT CAR NO. OR'1 ) \ 'l\-13 EL-Y ~,L '1lO \~ 'f.V~~8~1}.. 5'1"\ OOO~ETER ~31:.l..l'::-- ODOMETER ',J.Q '\ ~I"': OUT V '" I,j- Dq AN)3'1\" :\~$~ <.......l\~m ~ DATE DUE ......:~:,- ~ MAKE-MODEL.YEAR.CDLOR LICENSE NUMBER ODOMETER IN ODOMETER OUT \ ' , '~15" -?- MILES DRIVEN MILES Al.LOWEO - ")U) CHARGEABL.E MILES . ., Miles @ ts I Hours@ $ $ I Days@ $ $ I Weeks@ $ $ ; Months \ @ , a,. ,-,\A...., !r'1r:J Total Time and Mileage Charges $ O\..~ ~ l~,-, $ , $ ; , , , ,,_: $ '-'\""','7 ~r7 j $ ~.'''''' r..Lt:' $ -,....... $ , .-4- $ I Sub-Total I - , $ , , , , $ : , , , $ , , , , PERSONAL EFFECTS COVERAGE Sub-total $ ~$\l ~$\(T'lfo"lo'',J,_'" less Deposits $ I Net Amount Due $ $ Net Due Renter WARNING . I have read carefully alt driving and use restrictions on the reverse side. . I am responsible for alllraffic violations and must turn in all summonses upon return of vehicle. . I will report all accidents immediately. I have read both sides of this agreement and agree to its terms and conditions. I authorize you to process a credit card voucher, if any, in my name. THIS IS YDUR ~OICE ;-"AYMENT DUE ON RECEIPT x('-i \1A\--\Uhu \ ,J {J1.\ L ~'\ \. , RENTER'S SIGNATURE EXTEND TO .A.DD1TIONI\l C-.sH OEPOSlT OATE $ INlTIl\LS EXTEND TO INITIALS ADDITIONAL CASH DEPOSIT $ DATE CHECKED OUT ay; CHECKED IN BY: ""''''''''1' ADAmSD rW'lll?,,'" FINAL CHARGES ARE SUBJECT TO AUDIT iJiW~,;:,~-",=-II~il~iIO.!i.i__'->-';' - .J" _"""""""""",,o~."''''''''''''''~_ " ., - ~.-, " -~l ~~.~ tlltll&il_,,--,,-_Ho!"""""""'ff.l:<1-itc" RENTIREMENT CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG, PA 17055 (717),691 1880 8003821436 ?> . 642107 ( - - . \J\)\~\?-\ti~ AE n IN1}J). ,.A) f). II Jc,\ l..\4\.t: REPLACEMENT CAR NO OR US1.\-"" '3 , (. '" HOME~~Dr, ,&' MAKE.MODEL-YEAR.COLOA 1'a~~EY ... , __ ,_ ("!~r r. \\JC Io.l. - . \rJ I to, erN :J..... \ Rr1 'i STATe LA ZIP CODE LICENSE NUMBER ~~AaSC\~ lAP '10P.oa - OAIVEC ~~Ol-'I' ...I. .J STAt. A \" \1 ~O~ ODOMETER ODOMETER 1~,rJ ". ~ , IN IN J'-' ,0\ B1Ari In, \ SOCIAt. SECUR.lTY NO. HOME PHONE OOOMETEA OOOI.tETER ~~5, , , OUT OUT LO~" Mrnp~~ _ ,\DD~S l PHONE MILES II /.f 1 DA~O ~'i~ ~ -- .- . DRIVEN / MIJoo ; E~OY :) A PHONE "- I, MILES oet~'+\ q \0 "\~R r...~ ..... - " ,. ALLOWEO E ~6 I~ DDR~\ . L.,\~e.. ()c-,\. f:ls\.J ~ ~ ~ DATE DUE CHA.RGEABlE ~_IRA.TION OF AGREE~e N MIL.ES ("A:<rd, <"VI (JY;:~ ZIP Nc R~RStt~ C< ,;;3 '" . , I will not under any circumstances ' surrender the lIse ot the rented vehicle to any GAS person other than those listed below or in Paragraph 6 ot the back of this OUT IN Miles @ , e $ I agreement. Operation of the vehicle ~ any driver In violation 01 Paragraph 6 is Hours @ $ $ , prohibited. If none, print NONE across his section. E E Days @ $ $ , ~ Yo Weeks @ $ $~ I AO~~L~N~\ ~",,J) Hr\;Z~ NO.~ ,O;;';B'j Ii V, Months' @ ~ $ ,-" ILX;) '1\ - ~ ~~ ~ Yo Total Time and Mileage Charges $ ,;..t.,..,..,~ DRIVER'S LI ~N U "fi,R STATE/COUNTRY , ' jTKlNjTE e. 'e: $ , , Gas (Taxable) $ , RENteR'a PHYSICAL DAMAGE WAIVEA ......... I """"" ....... PHYSICAL , :~ES RATE $ \~.'\5 peR DAY $ ~ PER WEEK ACCEPTS DAMAGE WAIVER $ , x (NOT INSURANCE) , , By my initials, I accept or decline Physical Damage Waiver at the rates listed above. Sub-Tolal ~ $ '"'\nC.:;:7 'CJr " It I decline 10 purchase the Waiver, r accept full responSi~ility for loss by collision or comprehen- Sales Tax or Surcharge . . $ ~.",. rl.... sive damage. regardless of cause. up to $ 107.) 'I.. per occurrence, which may be Gas (Non-Taxable};:l. ~n t nu $ , charge~ to my credit card sho~n. ~elow. . _ CICDW (Non-Taxable) . /I $ I Acceptmg reduces my responsibIlity to $ -r":::J ~ per occurrence, which may be I charged to my credit card shown below. 'd.'/, ~ PHYSICAL OAMAGE WAIVER IS NOTlNSURANCE. fA.. rill riA I I l]j '1.1<"' I7kN - ~ . PEASONAL ACCIDENT INSURANCE (PAl) =-- J'!,' U , """,-By my Initials, I accept or decline enrollment tor perso~~ PERSONAL ACCIDENT $ , DECLINES ~ance. If I ac.c~t. I understand and acknowledge th .' rage ACCEPTS INSURANCe , , IS ~~ rates \\'1 \cated and that I have read rtlflCate of , insuranc nished by dealer prior to r~ I Sub.Tolal $ , X RATE $ PER WEEK X I , RENTEln ~ONAL EFFECTS COVE EC) AEIlI'ER"S , , """.". ......... B milials, I accept ,or decline enrollment for ~ Effects PERSONAL EFFECTS , overihae. It I acc8cW, I understand and aCknOwled~e that. r,~ COVERAGE $ , 7 is at t e rales in icated and that I h~e4ead t e certificate ACCEPTS , ~ SUb-Total , insurance furnished by dealer prior to rerita!. $ t X RATE $ PER DAY $ PER weEK X "'_ $ , - VEHICL~OIT~ SPARE CUSTOMER .. .' . $ \ ' i1\ ') OUT ~ ....~~ JACK O.K. INITIALS Less Deposits $ , ~C\('c)c..- V Net Amount Due $ , IN , RENTAL WILL. BE PAID BY Net Due Renter $ , "lo{15 WARNING . I na\le read c8relully all driving and use restrictions on the Te\lerSe side. DRC . I am responsible for aU traffic violations and must turn in all summonses upon REJECTION OF UNINSURED MOTORIST PROTECTION return 01 \/ehlcle. I am reiecting unin,,"ed motorist co'lerage under this rental or . I will report all accidents immediately. AMEX I ha....e read both side of this agreement and agree to \\s terms and conditions. lease agreement, and any policy of insurance or, ~If~insur.nce I aLJlhori::e yOL) to process a credit card voucher, if any. in my name. issued under this Bgfeen\ent, for myself. and all other pauen~ CB/OINEAS ger' af this vehicle. Uninsured coverag. 'proteds me and ather THIS IS YOUR INVOICE - PAYMENr DUE ON RECEIPT passengers in this ".hiele for 1011 arut. damages. suffered if x~ i "" ~ r~ \..0). 0..\ \ ~~ VISA iniury is caused by the negligenc:. of . driver wha does nat have any iRSllranC8 to pay foil' tosses and damage.. RENTER'S SIGNATURE MIC EXTEND TO ADDITIONAL CASH OEPOSIT DATE INITIALS ~~"::;~~ S\C\'n ~ t\\e.".te . OTHER I I EXTEND TO ADDITIONAL CASH DEPOSIT DATE INITIALS . CREDIT AUTH, NO I DATE 'TIME I AMOUNT I AUTHORIZED BY CHECKED OUT BY; CHECKED IN BY. ["'\""~'l' ADAmsD (800,132-0'" FINAL CHARGES ARE SUBJECT TO AUDIT __"""""'W~~"ldEililW""'''''''~IUI""",,"~''''~ " ~ ~~ . ~"'~ .~-= ..~.. . ~ '- ~"-"~~"~~"W ~~ ~,,__-,,;<,,;;".~~"""',k,"'T"'__'_~"'~ . . CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike '.' . MECHANICSBURG, PA 17055 RENTAL AGREEMENT (717) 691-1880 800-382-1436 '11I.'I'" \~Ur\.!:> 642323 :@ENl'(PRrf'.I\, 1'1. .. n \ 11 \ \1 . REPLACEMENT CAR NO, ORlG, ~I~u. '2... . .rv T"1 ~UVVI,.t\'n~ \)\,1..J HOME $5"2.... ___ r_ - Jl... \ . -- MAKE.MODEL-YEAR-COLOR ~~ y~ L"D -.. ,.,rc:A.5 D\\lC . "'b:\br~c;~ CITY fly. t.-..-. R ",\ ., Y STAt A- of:;}'"} LICENSE NUMBER r:;. F:.~JS' Co, ORWEmE5E~b\.\6~ STAr. A\ -\ T~~ ODOr-ETER OOO~,ETER I~l\' ~ ~ 81 THill G \ SOCIAL.SECUrtrYNO. HOME PHONE OOOJt,fER ~r ~rol.\~ Lr;~C~ r\ C_ ~r \,lO~ PHONE O":!~"N ~ \Ot1- OA~L.~ T E"~NP\C\ LV.....~. EM~)\JA ~\OU=("}S.";H~E L",'"ll'l ~ - DA5i~~\),\ E~~f)~~t\ORESf0_ ~f\~ p~..-\L.,A~f ' CHA~~~~BLE C(:a\D\\~ ~\~~ roc ~R~LE-jQ. " ~C;;RA , (qM.1S ( .DATE DUE F \ ~.... \ will no\. under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 of the bacll: ot this agreement. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. If none, print NONE across this section. GAS OUT IN ~ $ , $ I $ , $ , $"\:.c.~ be> $c:. ':.I ... '^r.... $ I $ I I , $ I I I - Miles @ Hours @ $ EEDays @ $ . ~~Weeks@ $ AOwr.~~ RENTEX ~Ec.\ ',r'o, 1 '11E P'WE t!O', '"'" DATE OX ~ Y, 'h Months' @ ~ IT \ \ 1\\, :. \ \ \- (J( ('" \ '-C~ lor / '4 3A Total Time and Mileage Charges DRIVER'S LICENSE1OI.:BAR\ A. STATElCOUNTRY ~TION ";TE ~ {F IT / / Gas (Taxable) ~~ PHVSICAL DAMAGE WAIVER ~ PHYSICAL Ol!l;if'ES \":1.. - c..l ~ t::" ACCEPTS DAMAGE WAIVER . 1\ RATE $ ,-J'~? PER DAY $' . \D J PER WEEK . (NOT INSURANCE) By ~ Y initials. I accept or decline Physical Damage Waiver at the rates listed above. Sub-Total II I decline 10 purchase the Waiver. I accept full rlsponsjbility for loss by collision or comprehen- Sales Tax or Surcharge sive damage. regardless of cause, up to $ 00 I. per occurrence, which may be Gas (Non.TaxableU ,II"; charge~ to my credit card sho~n. ~elow. _ _ . C/CDW (Non-Takable) 10 Accepting reduces my responsIbility to $ "--' - per occurrence, whIch may be charged to my credit card shown below. I t"..J. " PHYSICAL DAMAGE WAIVER IS NOT INSURANCE. 10. Ill) III ' 1'1~ V ~W"~s PERSONAL ACCIDENT INSURANCE (PAl) mAt.S l.\.'~ By my initials. J accept or decline enrollment for Perso ~ PERSON ~~CCIOENT OECUNES urance. If I accept. J understand and acknow~~t coverage Ai'V"'<=PTS INSURANCE ->.- is les indicated and that I hav~ tne certificate of ~ insurance fur bv dealer prior af. JJ+ $'"\hC.., Clt':> $ ~...... ~., $ I $ , - x """"'. INITlALS I Sub-Tolel X., I IUMnIt'S ........ PERSONAL EFFECTS COVERAGE --'- , $ I , , , $ : , , , $ , , , RATE $ __ L< PER WEEK PE Al EFFECTS COVE1'llI\QE (PEC) By my s, J acceJ?t or decline enrOllment~or naJ Effects ~ae It I accept. I understand and a&kf]pwledge tli verage DECLINES ,......rs-. at_ _ tn!" rates mdicated and that I haVe ."ead the certlflC of ACCEPTS t I ~ Insurance furmshed by dealer prior to reny..l i.'- S T' ~ ub- otal ,/" X RATE $ PER DAY $' PER weEK x Less Refund For: ~ VEHICIfR,.ONDITIT~ ~ SPARE CUSTOMER- OUT I\X'..J l Jc.("(\,~ t.,., c ~ JACK O.K. INITIALS ~ IN ~I'~p '-J RENTAL WILL BE PAID BY IN) $ $ I $ \CDE:: I i-l. .., $ , Net Amount Due $ $ ORC REJECTION OF UNINSURED MOTORIST PROTECTION Net Due Renter WARNING . I have read carefully all driving and use restrictions on the reverse side. . t am responsible for all tramc ",ioIatiQl\s ~ must turn in all summol\5eS. upon return of vehicle. . t will report all accidents immediately. I have read both sides 01 this agreement and agree to its terms and conditions. I authorize you \0 process a credit card 'IO\.lcher, it any. in my name. VISA I am reiecting uninsured motorist coverage under this rental or tea.. .greement, and any policy of ""uran"e or se-lf.inlU,.nce issued under this agreement, for mysel' and .11 other passen- ger' of this vebicle. UninsUf8d cove,age protects ..... and other passengers in this vehicl. for I~II and dllm.g.s suffered if iniury is caused by the negligence of '. drhBr who does not have any insurance to pay for 10.... and damag.s. AMEX CBIDlNEAS OTHER R~nt.r" ~"\' ~ rL \2'\\e. Signature 0' I "- ,~ V"{1 THIS IS YOUR INVOICE. PAVllENT DUE ON RECEIPT X 5\"T\~~\-GL\\\3~ ... I ACNTER'S SlGNAlURE EXTEND TO ADDITIONAL. CASH DEPOSIT . DATE INITIALS MIC Oat. I I EXTEND TO AODITIONAL CASH DEPOSIT . DATE INITIALS CREDIT AUTH NO I DATE - , TIME f AMOum AUTHORIZED BY: CHECKED OUT BY: CHECKED IN BY: '.""'~'~' ADAms rI <^<' ',",... FINAl ~HARr.~~ .aPE:: CliO fC'....T Tr"I "",......,. ~,,"Mi'!l,tl~,,",~'_~IIllo~_'_',",,' -r-' ." ~'"-"''''.''''''';:-~-~~ ~.. ." " , RENTAL AGREEMENT ~,""""'" ~.~- ~.~ "-"~"~;'ilrii.~t ,'m" ...~ CUMBERLAND VALLEY MOTORS 6720 Carlisle Pike MECHANICSBURG, PA 17055 (717) 691-1880 800-382-1436 w'J.- \.?,t:. ~\~ REPLACEMENT CAR NO ORIGr1 l-' ,3 I 'e!\E'~El' " \-.l, I... " E~-....t::Z:l'" ~ 0 -..:.l.J\'"\ ODO~ETEA ;:2.. ~/ '"'" ~uf"" ~l \'i(.. 7~'i TIME '"4:1 ~ ~ AL~ED, ~~ OA~"'I! ~l.\I5"= -~ OUTIN~ Hours@ $ $ I Days-Z @ $ $ \t'U.'J'V'o.. Weeks I @ $ @ :l; 7 c;:u f"V'"\ Months @ $"\.0> $ I Total Time and Mileage Charges $ \ I $ , $ , , , , , , , , ~%=,~ ,.,~ E E 14 \4 ~Lrs:RN ~\=\tdll"~N\~ &jBj ,~ ~ ORIVER'~E N~ STATElCOUNTRY EXPIRA~ fJA,TE :(t: F 1,...1\ 1 Pt / I Gas (Taxable) ':"= PHYSICAL DAMAGE WAIVER ~ PHYSICAL , . ~ XDE~S RATE$ \~.~ PERDAY$~l.G PERWEEK :COEPTS (~~~~~~U~~~~) By m initials, I accept or decline Physical Damage Waiver at the rates listed above. Sub-Total $ If I decline to purchase the Waiver, I accept full responsibility for loss by collision or comprehen- Sales Tax or Surcharge . r n I. $ sive damage, regardless of cause, up to $ ----\.lffi.L- per occurrence, which may be Gas (Non~Taxable){J ,t;I H (if 1) $ charged to my credit card shown below. _ C/COW (Non.Taxal5le) J f'\ $ Accepting reduces my responsibility to $ - G - per occurrence, whIch may be" " I charged 10 my credit card shown below. .. A.. , PHVSICAL DAMAGE WAIVER IS NOT INSURANCE. . l\ /tI1l1!)' 1lA1\ ~ rn ~ ~ PERSONAL ACCIDENT INSURANCE (PAl) , 3)..1 . . \\ . By my initials, I accept or decline en(Ollment~or Personal . PERSONAL AC~ENT DECLINES ~t;lce. ".1 accept, I understand and acknowled e overage AN";EPTS INSURANCE is at ~tes indicated and that I have re certificate of ~...-- insurance fu d by dealer prior to re I Sub. Total RATE $ ~V $ PER WEEK X I r,n.. ~ERSO FFECTS,~~GE(PECI ":.:w~ _Q By my rnltlal ccept or decline enrollment rsonal Effects ~ERSONAL EFFECTS DECLINES Cover a acc~t. I understand and :ek~Wled~e overage COVERAGE IS a e rates III Icatedd and that I h r\t~r ead t e cerlll of ACCEPTS t. rance furnIshed by eater prior to re,\"", ~ Sub.Total $ X ~ RATE $ PER DAY $ , PERWEEK.x ~~ $ t1EHIC E~ONDITI~ .S~A!!.~~ CUSTOMER _ $ OUT 1\ \ ^ \ c:.. - - JA. ! AlliI6U.. 'LeSs lleposits $ '1..-1... - ~ lill IN], ~ T"JII ),' 1 i<... ~., ~ "':::' <..J t"'I'et Arnounl Due $ I~A;~~'DlIY ~.;.;: .f'A~t>r-.:.'7')A l~ ~ '(, If~ ~:~~~~ Renter $' I I ( ~ 'J t("" Uf I J. 17 n 1'1 r I" IJ I II J . I have read carefully all driving and use restrictions on the reverse side. DAC . I am responsible for all traffic violations and mustlurn in all summonses upon REJECTION Of' UNINSURED MOTORIST PROTECTION 'e\urn ot vehicle, . I will report all accidents immediately. I have read both sides of this agreement and agree to its terms and conditions. I authorize you to process a credit card voucher, if any, in my name. F1ENT~ lPRffif If ..n.f'L, ',' ..I . .- . \""11. ;. \~Pt: " \)C~~\\. ~~\L.\\l'\'" HOM~~\^ r f'_r. <C5S e,\l'V" . CI~_\ ~rA;:r STALA,. I{;:~ D"~~&"bo'-\~ STC A . ..,... ...\ - \~.~ Bf,H~ (;, \ SOCIAL SECURITY NO. HOME PHONE c\=.Oer~\e- E~~ ~6\-;rESS - L ~ h,,", 0.,,\ 0 Ur::5 r:.o;~ 1:; l:\ :i. E lr~';jSt\DREK ~~G- ?cs \~ Ave.- {A(b\\r-i ~,,~~ Alr. caP.'1E\:~~ PHONE I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed _ below or in Paragraph 6 of the back of this agreement. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. " none, print NONE across this section. X RENTEA'S ""'.... AMEX , 8m .ejecting uninsured motorist coverage under this rental or lease agreement. and any policy of insurance or .elf.;nsurance issued under this agreement, for myselt and all other passen. gers of this vehicle. Uninsured coYerase proteds me and other passengers in this vehicle for loss and damages suffered if iniury is caused by the negligence of a driver who doe. not have any insurance to pay for louu and demages. CB/DINEAS VISA MIC ~~:::~~o :l' DY\Dn ~ \ eo.to I I OTHER CREDIT AUTH_ NO. DArE AMOUNi AUTHORIZED BY TIME 642613 MAKE.MOOEl-YEAR-GOlOR lICENSE NUMBER OOOMETER IN ODOMEiER OUT MilES DRIVEN ,... \ $ I \ '" ",,-, , _I"L""I 'I~ \9..'f"'v'"\ $ $ I"V '\/ r N '" {'-I~'( A' $ , , , , , , , ":;l. 7', , I , :;:~:~r;c:~~ON~~ \2n l I RENTER'S SIGNATURE ExTEND TO ADDITIONAL CASH DEPOSIT DATE S INITIALS EXTEND TO ADDITIONAL CASH DEPOSIT . DATE INmAL.S CHECKED OUi BY: CHECKED IN BY: ''''''''''''>1' ADAmsn II(:tI,nl..,.. FINAL CHARGES ARE SUBJECT TO AUDIT _,' 'w="J~ . ~ ..........--. .---....... ,............ I......' -.on... 8720Ca__ MECHANICSBUAG. PA 17051i (717)181'1180 _,. AEHTeR~:":' ."':" ,""'.'i,",:"," ..". .,.. " ',' ;);' R.PlACEMENlCARNQ, ,,', ., :,' ',' :,oc,' ,,:,,'[:,', """.: ,<., , . - - ',;'- .. - '",', ", "__ .,,"r j,__.~,_j._';, , "', . )J . '-"'\\ c."~~~: A\-\c I MAK'-MODEL-YEAA~OR ( r.1lY r fA ~D\\ '<"\" ~C,\-.. NC bt l6'l1-dfs' LIC.NSENU....ER DAIVER'S UCENSE NO. STATE ",...~,~;o.~>l"'~'*'-'''''',.~,..'-...i~o'''""~'"iLl:lIlti . RENTAL AGREEMENT EXP. DATE BII'; / lOCAl CONTRAct SOCIAlSECUR~~. -r... HOMEP~E""" '1'0-45'n -o5."'W ADDRESS , . ~~. ,.P!;!?N~ \ ~ \D - ~ '"+0{ -l.\o.:Jr;;, PHONE EMPlOYER EMPLOYER'S ADDRESS CIlY STATE ZIP REFERRED BY I will not under any circumstances surrender the use of the rented vehicle to any person ottler than those listed below or in Paragraph 6 on the back of this Agreement. Operation of the vehicle by any driver in violation of Paragraph 6 is prohibited. 11 none,.print NONE across this section. GAS our IN E" E ~/4 1/4 ~" "'~-"1!lIJ~2.;c,;h"""_.,;"",~__~"""-,-~".",,,,,"~_-:,,,,_..tk""o'_-'_lli')@~::- No. 643283 K I .\..)rlI\~6::' l~qEL;1?-~L~ LI~~~BE:'5\() c;- ODOMETER 1"'"\..... ~ _ IN r,"Y "\ ~' ;r;:;1.1" ~~;"itsl~",~~ ~p .IL ~~:,~..-, P!J~:' ODOMETER IN ODOMmR OUT MilES DRIVEN ,/1/,,:"\ ...~ \ ",,",.t"'\ .W .... $ $ $ $ $ $ $ $ Cl~"",", , , , , , , , B= , , , : . " 'MIlES . ALLOWED CHARGEABLE MIlES Miles @ Hours @ Days =i Wee!Is . oc.. Months! @ ~OO Tolal TIme and MIleeoe Chames Gas (Taxable) PHYSICAL DAMAGE WAIVER (NOT INSURANCE) Sub-Total $ales Tax or Surcharge ;oJ...... ....Ii l:ras (Non-,axable) J '), C/CDW (Non-Taxable) PERSONAL ACCIDENT INSURANCE PERSONAL EFFECTS COVERAGE $ . $ 'f1') I I $ ~t1 $ I, $ G $ $ , , -, , $ Sub-Tala! $ $ ~$ Less Deposits $ lC~ ?J ;;;S:DBY DRC REJECTION OF UNINSURED MOTORIST PROTECTION AME>< I am rejecting uninsured motoriBl covarage under this rental or leasB agreement. and any policy of Insurance or self-insurance iSBued under \hIs agreement. for myhlf and all O\har passen- gBrs of this vahlcle. UnlnBured coverage protects me and oIher passengers In this vehlcla for loss and damages sultared If injury is caused by the nagligence Of a driver who does not have any Insurancalo pay for Ioas88 and damagas. Renlafe () Ill}! J Signature ~ ""I'IME V I AMOUNT I AUTHORIZED BY; , CBJDINERS VISA '11C Dela/IIZ~,fi OTHER CREOIT AUTH. NO. fATE Net Due Renter WARNING . I have read c;arelully all driving and use restrictions on the reverse side, . I am responsible fer all trafllc violations ancl must tum In all summonses upon return 01 vehicle, . IwiUreportallaccidentsimmeclialely. I have read both ~ this agreement and agree to ~ }lilnnS ancl conclitions. lauthorize;~;;~ssacredlt r,ifany""~name.".,,. ,.' THISIS~_lNVOr;. '..,4,',: ,', " 'H X \ - . -- 'SSlG J'URE ADDITIONAL CASH oeJloSIT DATE $ ADDmONAl CASH DePOSIT DATE $ _~DfJ\BY; Net Amount Due EXTEND '/ EXTENDTQ FORM CFO-252 PA-4 . _(1.-79350) rt'iT\&1l'-4m' ADAM. U'\IllO\2!lUTII FINAL CHARGES ARE SUBJECT TO AUDIT ~ $ $ INITIAlS INITIALS Cl\:E:;~ '-.J FRONl !lillIlI:hiJlimd._""",,;"'L'~'r'>;!-""~ ",-,""tv,,"",,," RENTAL AGREEMENT ';;'''.lI'U~'''f"'~I'''ioI ..""...."': I~V.V,.:.~ ~~~,-~- "10..' _~-~"""",,,,,,,",,,,,,,,,~,,~,,,,,,,,~,,,_>,'''''';;'"''':><'''-1,W;:Hj=_''\''!;<it'f.lk/.' 872ll CUlIIt ..... ~~= No.643444~ Mi HaulS @ Days @ l..I- _Qe Weeks @ .t'n n~RENTER~~Q:V~ I<<lMEPHONEN": "\\^~~/"':: ~: ~~";,il~:d:;'~haraes D~~'~UCENSE NO. STATE/COUNTRY EXPIRATION DA'l! ~ bI&-\D~\lo ~ hi H..ul IF llas(Taxable) '1ll\\lt'1 PHYSICAL DAM~ WAIVER ~ PHYSICAL DAMAGE D'f\;''f'S \ a Q< ~..,,.. ACCEPTS WAIVER X \Y- RATE $ U' ~ER DAY $ , \ ~lb &:-..... PER WEEK X (NOT INSURANCE) By my mltia/s, I accept or decline Physical Damage Waiver at the r~t9 Iiste above. Sub-Total If I decline to purchase the Waiver, I accept full responsibility for loss by collision or Physical damage, regardless of cause up to $ "I'C' 'll per occurrence, which may be Sales Tax or Surcharge """ ti. charged to my credit card shown below. 0 ;::v 'I \ccepting reduces my responsibility to $ per occurrence, which may be ~/V\ c.~ ..:harged to my credit card shown below. PHVSlCAL DAMAGE WAIVER IS NOT INSURANCE Gas (Non-Taxablell .A.JI ~. PERSONAL ACCIDENT INSURANCE (P.A.I.) ~ C/CDW(Non-Taxable) , \ ~' By my mitials. I aecert or decline enrollment for Person Accident ~ Insurance. If I accept, understand and aCknowledge that ~coverage is ""CE- at the rates indicated and that I have read the certIficate of insu ...... ..- , '" furnished by dealer pnol'" to rental. RATE $ PER WEEK X ",,,'s AL EFFECTS COVERAGE (P.E.C:r--....... " "mITIALS By ltials, I accept or decline enrollment for Person E~ ~ ~:. rage. " I accept, 1 understand and acknowledQe that coverage is DECLlN (ES r1:'t the rates indicated and that I have read the certificate of insurance :\EPrS furnished by dealer prior to rental. ~.. X RATE $ PER DAY $" PER WEEK X Sub- Toml VEHIC~D":''':' /\'-~,' n. ...... '..... SPARE tf~J~ OUT I 'lln-r-urnVe I("+I""IOI~\' ~ _ c; 0\0") e.- Less Deposits ~.-. , -,--~ -~ <~ ~~'9 is,',':;:;:,;;,;;,,,;",,,,,',,,' . ,'.. ,O'''''",,,,;.'~":; HOMEAO\OZd."'~.' 1()'\.0~~V" '.,' CIlY '(\ l\ \\."- \, N"\ \":2 ~1.. ~ ~~9-. DRIVER'S LICENSE NO. STATE EXP. DATe BIRTHDAj / lOCAL CONTRACT SOCIAL SECURIlY NO. , _ _ I<<lME PHONE_ Q\O 4"- CeJ ..... ADDQ\() ~ L\'l{H~i PHONE EMPLOYER EMPlOYER'S ADDRESS CITY STAlE ZIP REFERRED BY I will not under any circumstances surrender the use of the rented vehicle to any GAS person other than those listed below or in Paragraph 6 on the back of this Agreement. our IN OperatiOn of the vehicle by any dr~ver in violation of Paragraph 6 is prohibited. If ::itF E none, print NONE across this section. :;-::. 94 1/4 ~s X IN RENTAL Will BE PAID BY DRC JOd5 REJECTION OF UNINSURED MOTORIST PROTECTION I am rajectlng unlnsurad motorist coyarage under this IIIn181 or laase sgreemant. and any policy ollnsuranca or saN-lnsuranea issued under thla egreamant, lOr mys.W and all other ll~nen- gars of this vehlela. Uninsured coyaraga protects ma an~ othar passengars In this vahlela for 1088 and damagea auff.red II Injury Is ceusad by lha negllganea of a driver who doas not have any Insuranea to pay for 108llas and damaga.. AMEX CBJDINERS VISA '~/C OTHER 1 " _ l^r. ) \ II om. J J /?(/ 00.... Rentef. Slgnetu" I DATE liME AMouNT I AUTHORIZED BY: CREDIT AUTH. NO. ~~(~~:t~.::,: ~~EL-VEAII-COIE" ~\~~ ~ttER~. _ O~ET1lR \~~~ 7000MiiER:'>o '- ~~;a.";C'n';::::~~i~,"" our n -,;) ,~~:va:~~~~~ . '\1... ",. HI ~....' \ ~ dd.. REPLACEMENT CAR NO. MAKE-MODEl-YEAR-coLOR , UCENSE NUMBER ODOMETER IN ODOMETER OUT MILES DRIVEN ~!;'~-"'iJ"' ALLOWED CHARGEABLE MILES . , PERSONAL ACCIDENT INSURANCE Sub-Total I>ERSONAL EFFECTS COVERAGE Net Amount Due \ '.~ "2..:' ,~. $ "0", $ , $ : $ , $ ~ J..M ;Dr-. $\ \ c...o,. 'o.\..r_ $ : $ , $ $ \\ r,,0I- ~ $ 1 ^ r::; ;-3 c:- $ , $ : $ $ , , , , , , $ , $ '- $ IJ 1'+ ,{~.., $ : $ $ Net Due Renter $' WARNING . I have read carefullv all driving and use reslrictions on the reverse side. . I am responsible for all traffic violations and must turn in aft summonses upon relum of vehicle, . I will report all ac:cklents immedIately. I have read both sides of this agreement and agree to lis terms and condItionS. I authorite you to process a credlI can:I voucher, n any. In my name. THISIS'lOURINVOICE'PAVUENJ'oueONRECEIPJ">' ''';'".', ,"_ .':- X'~~-(\-:..:....... '. ,. . ...I/:~''';' , INITIALS EXTEND TO ADDITIONAL CASH DEPOSIT DATE $ 8ITEND TO ADDITIONAl CASH DEPOSIT DATE $ CHECKEDOUTS~ c:::" C~'~ FORM CFO-252 PA-4 . (L-79350) ::'l71D'l'.f72T.ADAJlSn.....,." FINAL CHARGES ARE SUBJECT TO AUDIT INITIALS FRONT ~\lli'~~_"~-" ~~ "~~~,=, -. "- ...,"" '".. ~~~ I .._~~ ~~ - , ,=. -'''''"'''~''''''''_''L''-'''''''''''''~~=I~".~_M'tllli~,,''-;: RENTAL AGREEMENT- . ' . CUMBERLAND VALLEY MOTDRS ~'1--;:::" " ~~~~~= f() , N~. 643571 ~ RI=.:PlACEMENT CAR NO. DA~ AND TIME IN 1JSL:. ':'...1 .en r...,..., ~ 1~, ~AND~~A":" "'..,. '"~.I \ \l .\ I / ) AlIl'\I ~ \) ~~~~ CHA~~~LE . . . OF N-.. ..~. GAS OUT IN Miles @ $ I "~:jE,~i E Hours @ s, i;~ '/4 Days @ FU.C't'o $ : Weeks @ ~.- $ , (~\nR~l\lf",tLi HOMEPHONE~;;~I reJf\~I? :: :: ~::~:"andMlleaae~~- : ORIv;...RI5;..C'~s~ , STAT~U~RY "~'~~,.......... $ '~l ~ 'ILl, ~', '" I\. ". 1\ I ,\(f)' F" t' Gas (Taxable) $ ~ ~CALDAMAGEWAIVER ~ PHYSICAL DAMAGE "fV'f'ES , ~ ~..... f ~ ~ ACCEPTS WAIVER $ X \li- RATE $ -l V . PER DAY ~ PER WEEK X (NOT INSURANCE) ~y my initials. , accept or decline PhYSlt'c~all Damage Waiver at the rate Iisteo above. Sub-Total :g) $ If I decline to purchase the Waiver, I accept II respqn-sibility for loss by collision or Physical S "Ii S $ damage, regardless of cause up to $ \ 1'0"\. . per occurrence, which may be ales ax or urcharge . , . c:harged to my credit card shown below. \" ~ . ".) "/. $ ccepting reduces my responsibility to $ per occurrence, which may be r L ~ fU\ \ \ n~~7 $ ...nargedto my credit card shown below. II-U.J lJ...l~ ~ PHYSICAL DAMAGE WAIVER IS NOT INSURANCE Gas (Non-Taxabllil ':1 I PERSONAL ACCIDENT INSURANCE (P.A.I.)_s C/CDW (Non-Taxable ~ ~.njtiaIS' I ac!cert or decline enrollment for Person Accid lnsuranc. accept, understand and acknowledQ.e that co is [lEClINES at the rates in d and that I have read the certlfica Insurance ACCEPTS PERSONAL ACCIDENT furnished by dealer to rental. INSURANCE RENTER \?T9...'~:::, ,..'.. . '" (-::iN i-\-", ""'.,,.<,;.:... ..... .,. """,,,,C:>,., ....,'.. HOMEit\2.Q N. 1.11 kP ~N~_ ~, CollY /\ _ , , .~,., f').. .S~TE _.. \ '" .-. ZIP CODE _ { 1(\ 1^\1J T j 1 'll 1(111 !'..\( l!:::lf EXP. DATE - DRIVER'S UCENSE NO. STATE alATHDAj / LOCAl. CONTRACT SOCIAl SECURITY NO. q \C\lJ~HO~P~....... Q\l\ ~^ ~~f'l\ PHONE ADDRESS EMPLOYER eMPl.OYER'S ADDRESS CITY STATE ZIP REFERRED BY I wm not under any circumstances sunender the use of the rented vehicle to any person other than Ihose listed below or in Paragraph 6 on the back of this Agreement. Operation of the vehicle by any driver In violation of Paragraph 6 is prohibited. If (lone, print NONE across this section. MAKE.MODEl..YEAR..col.QR ~~. .. J.::)) J-J ') " a- OR , L.1-t 1':::: C""l ~ UC~ENUMeER_ ....- 0)(1. ~It r., O~ETER~ '1..\ SL\ ~ '~R' \~~J.. '. ,~ , LICENSE NUMBER ODOMETER IN ODOMETER OUT MILES DRIVEN :t:~ lMLes' ""~ ALlOWED <..f~T~ . . '1, SE.:~ $ RATE $ PE PER WEEK X ""NTEWS P~RSONAL EF :TS CAGE (P.E.C.) INITIALS By my initials, I ac or decline enrollm r Person Effects ~weJ's'S- Coverage. If I , I understand and acknOWled~~erage is DECLINES at~the-~icated and that I have read the cert icate . ranee ACCEPTS ~ by dealer prior to rental. 'I. '* "...' ............. t, x..---- RATE $ PER DAY $ · PER W EK X --....... Sub-Total vEHICL~"" ~DIT'2!' t ^. \--r-..."U;)f'7- ~~, SPARE \,,<;,~,l, Less Retund For: OUT! W 1-1-( \1 r -" ,'K'.L Ul\-IJ \ fNI'II'\S"'~ IN ~ t, - Le.. Deposits RENTAl. WilL BE PAID BY , ': '-, '.. ' - Net Amount Due X f ()';;J~ DRC REJECTION OF UNINSURED MOTORIST PROTECTION I am rejecting uninaured motorist coverage under this rental or lease agreement, and any policy 01 Insurance or aelf.ln.urance issued undar this agreement, for myaell and all other passen- gers 01 this vehicle. Uninsured coverage protects me and other passengers In this vehicle lor loss and damages suffered " Inlury Is caused by the negligence 01 a driver who dOllS not have any Insurance to pay lor lones and damage.. ArJlEX C8IDINERS VISA ,.<; Of HER =~~~~.~ D D.- Il/z?J~ 1 DATE I TIME I AMOUNT AUTHORIZED BV: Cf\EDIT AVTH: NO. Sub-Total $ , , . . . $ . . . . $ : $ . $ It 'I '10<." L'\ $ i $ , , . PERSONAL EFFECTS COVERAGE Net Due Renter $: WARNING . I have read carefully all driving and use restrictions on the reverse side. . I am responsible for an traffic violations and must tum in all summonses upon return of vehicle, . IwillreportallaccidentSimmedlal8ly. I have read both sides of this agreement and agree to Its terms and conditions. I authorize you 10 process a credit card VOUCher, If arty. in my name. THIS I~ IHYoICE'~ ~EN:r DUe ON RECEIPT, -" .'.- \.::;;N~J'-\ J..- X II"Y RENTEA'S SIGNATURE ADDITIONAL CASH DEPOSIT DATE $ ADDITIONAL CASH DEPOSIT DATE $ CHECKE~ e:: ,...., .\ ,\, y.) ,dO EXTEND TO INmALS EXTEND TO INmALS 1\~~OmB"-' Ii. )1) b~ FORM CFD.252 PA.4 . (L.79350\ FINAl r,HARGES ARi= SUB.JFr,T T() AI IDIT ~ FRONT _~~"->,~~,_,~"""""Cc<4~=,~,"hl",~-""'WiI!L"dj,,,~~\if;-'f. --~~>,\: , .'- .~~ - ~~ .. = .J"~ CUMflER~ND VALLEY MOTORS .....CmIIoIe "'"' MECHANrosBURG,PA1~ '643793 R. RENTAL AGREE!'4~Nr (l'7j"",BBO 800-382.1436 No. ~,~(;;';'~l " ,,;,,;t'iih'?i;(; REPlACEMENT CAR NO, "", :7~ "ilU'if"'\ ,c\"'-\r,J~.f';}\'iit"h('!.i;;;i: tIDME,.;t- ~\'\r ,....:;'~"~.~' ',f:' ~ '''', " \,;' MAKE.MODEL-VEAR.COLOR (CoITY h """\ \m C:::icSTrT\,\ ~r ~..Z1PCO~_~ LICENSE NUMeER DR~~U;~ \I 1\ )\ [/l\E \ \_\ \~TE O~NETER ~ \l /(jf A SOCIALSECURITYNOq\OI \,.- )\O"'EPHONE-.) ~ ADDRESS C\ \D Ll f~ l~" \ X RATE $ PER WEEK X ,,"";\. I _ _~ AL EFFECTS COVERAGE (P.E.~! "",,'s iNm1ii.S"- ~y JPrlnltials, I accept or d . tiQ[l Effe~~ INITIALS 11 I nd and acknowledp that ~ -, DEC'L('INE at the rates l~alcated and that I have read th, e certificate of insurance ~ACCEPTS furnished by dealer prior to rental. . -... X RATE $ PER DAY $ " PER WEEK X Sub-Total $ VEHIC~ONomON "." 0...., _ '\.. ".1. d'~ '" CUSTOMER less Refund For: $ OUT'\"\I"\\'-( V\ \:l\' ~~"\YIliiTtALS ~$ IN ~ rrv7 Less Deposits $ RENTAL WILL BE PAID BY " -. , -,0' Net Amount Due $ W.'_""~4~" LOCAl CONTAACT EMPLOVER PHONE EMPLOYER'S ADDRESS STATE , I will not under any circumstan"ces surrender the use of the rented vehicle to any GAS person other than those listed below or In Paragraph 6 on the back of this Agreement. our IN. Operation of the vehicle by any driver in violation of Paragraph 6 is prohibited. If ,'E~1 E none, print NONE across this section. -'':'~' '/4 1/4 CrTY ZIP AEFERRED BY :RL~'s~(\:~~\7@t[~E ~;: ~ .. , __Pt/!ICAL DAMA9J\ WAIVER ~ x\l RATE$~PERDAY$~PERWEEK X>CCEF'rS I;;;;~ my mnials, I accept or decline Physical Damage Waiver at the rate liste aDDve. If I decline to purchase the Waiver, I accept ~II r8SPQnsibility for loss by collision or Physical damage, regardless 01 cause up to $ ~{Y)'(. per occurrence. which may be charged to my credit card shown below. ~ cceptlng reduces my responsibJllty to $ per occurrence, which may be .nerged to my credit card shown below. PHYSICAL DAMAGE WAIVER IS NOT INSURANCE PERSONAL ACCIDENT INSURANCE (P.A.I.) ..J.... ~ By my initials, I accert or decline enrollment for Person Accident ~- Insurance. if I accept, understand and acknowl~e that coverage is if-r DeCUJfES at the rates indicated and that I have read the certificate of insuran~ ,.........CEPTS furnished by dealer prior to rental. ~ -~,(""\c::. '(~, "' ORe REJECTION OF UNINSURED MOTORIST PROTECTION AMEX I em rejecting uninsured motorist coverage under this rental or le..e agree men', end any policy of ,insurance or self-Insurance issued under this agreement. for myself and all other passen- gers of this vehicle. Uninsured coverage protecls me and other passengers in this vehicle for loss and damages suffered If injury is caused by the negligence of a driver who does nDt have any insurance to pay for losses and demages. CBIOINERS VISA '.'C OTHER R.nte(s..\.~,Gl\ /f)(\ ~ ~ 1\ \ \ I ~ 1m Signature Da1e _ C1 .:J::j I DATE r....J I TIME AMOUNT I AUTHORIZED BY: CREDIT AlJTH. NO. MILES DRIveN ORIG..?RNO. .,,\.,,~-,,~,"r't;;...;~L~\~: <" "{;.;l\~ ",,',",\. ri,,~~ )If '-r1\ T'\).I UC~NuMeE~. ,L ~ 'r"iI..\\ ~\I' '"\ O~ETER~i\ (,,::J.O ~ ~i~~'Lf?:tl~ ~}!~~;~f> :~~z;~~,~ "7 ,,,", ,,'.O!'\~\" -, '.,,-11. ""'MIt.Es'\'~" ALlOWED CHARGEABlE MILES ~ '" ;i Miles @ '"', $ , Hours@ $ I Days @ rl:.ll' , $ : Weeks @ $, Month'" @ Lt~ ;.;.. '\ $ c:r::r" A'...^ Total Time and MlleaaeChs...... $~ '" r>o.r, $ : $ , Gas (Taxable) PHYSICAL DAMAGE WAIVER (NOT INSURANCE) $ Sub-Total . $ Sales Tax or Surcharge ...L .., $ ;::::;"/. $ ,:;)/;/0 J,J"" 1ii:v $ Gas (Non-Taxebliif1..-,'j,. 7l ClCDW (Non. Taxable) U "'\..t ..., ',,... w::z, :J.'t - -- , i PERSONAL ACCIDENT INSURANCE $ Sub-Total $ PERSONAL EFFECTS COVERAGE $ \ Ul77\:~ , , , , Ne1 Due Renter $' WARNING . I have read carefully all drivirlg and use rewk::tionll. on 1he R!H6fI8 aide, . I am responSible lOr all traffic v1a1l!tlons and must bJrn In all summonses upon return of vehicle, . I will report all accidents irnmediately. I t\ave fead both sides ot this 8QM8ment and agree to its terms and CO(W1Itions. I authorize you to process a credit card VOIJCher, If any,ln my name. THt~ ~~'''''''''ENT, DUE ON RECE,tPT'" , " x~td\{~~~f2- ' EXTEND TO AODITIONAL CASH DePOSIT DATE JNITIALS $ ADDITIONAl CASH DEPOSIT DATE $ ',. ( EXTEND TO INITIALS CHECKE Ie:""" CHECKED IN BY: .~~ I 'lvr-\ , --., FRONT FORM CFO.252 PA.-4 . (L-79350) "'17' ";--I;',~. ADAMS n . ,-eo~) ~.'~-67" FINAL CHARGES ARE SUBJECT TO AUDIT ,"i<li"~ili",il;:'~J'" L " "";"'''Igt;n~l'il.l VA.L.L.a::.l -MOTORS 8720CorI1oIo..... MECHANICS8URG, PA 17l15S (717)"'.1880 _14S8 1lIIll!;;.,~_"""''''''''''''''-"''-''-''--''"-"'~'.'~''-''~ RENTAL AGREEMENT , ff'~c:c~r'F;;_ HOM\{\~ 1\J.L.o.\\e:~';~d~"f..5A l{€i',:.," ("lTYr.(u\6\'~C\ o.._~\~All! f\)C.. ~e~~X ~;"I'l~NO._\ c., Wr. \\. \\0\ "'"\fi\ \ }\: C, SOCIAL SECURq \0 _ ~ 5Sf -O~'; ;:) LL?\~~ N~rRESS PHONE EMPLOYER ~ \() P~$s l..\ 1/'.;. \ EMPLOYER'S A.DDRESS " CITY 57"'E ZIP REFERRED BY I will not under any circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 on the back of this Agreement. Operation of the vehicle by any driver in violation of Paragraph 6 is prohibited_ If none, print NONE across this section. GAS our IN :~1;it E '-~,,!.~ 1f4( 1/4 A\\Rzr~i~\F~ ~;r:,~ ~;r8l"j"" :: ~: DRIVER'SU~f01t STATE.<XlUNTRY EXPljlONiTE ICE: F ~ PHYSICALDAMAGEWAIVEfl....~u OE~ES ':l q5' c.l (0, ACCEPtS X 11 RATE $ \:, PER DAY $ I. PER WEEK X jjy my 100tials, I accept or decline Physical Damage Waiver at the rate Iiste aDove. If I decline to purchase the Waiver. I accept full re~ibility for loss by collision or Physical damage, regardless of cause up to $ t n~T9 per occurrence, which may be charged to my credit card shown below. ccepting reduces my responsibility to $ -0 - per occurrence, which may be \. . ..narged to my credit card shown below. ~ PHYSICAL DAMAGE WAIVER IS NOT INSURANCE PERSONAL ACCIDENT INSURANCE (P.A.I.) .; , . By my initials, I accert or decline enrollmen;,~, Persoll.Aceident ~" Insurance. If I accept, understand and ~~OWI e rage is A,CCEPTS I ~tes indicated and. thai I have read iCate Qf insurance furnish ' er prior to rental. DECUN X ORC AMEX I am rajecllng uninsured motorist covarege undar \his rental or lease agreemenl, and any policy of Insurance or self.lnsuran,ce, Issued under this agreemenl, lor myself and aU other passan- gera of Ihls vehicle. Uninsured coverage protects me and other passengera In Ihls vehicle lor loss and damages auffarad II Injury Is caused by Ihe negUgence of a driver who does nol hava any Insurance to pay lor Ioasas and damages. CBJDINERS VISA .,'c :~ 5\~ ~()'n ~ ;\e. DaIs \ \ ~ 9'f'\ OTHER CREDIT AUTH. NO. I DATE I AMOUNT I AUTHORIZED BY: I TIME '""""~"- "-~, __~~~,',c""'-"~""''-~',..""';,'_''''',,"...,,"~>,,.~- ,."ti"~'~M""O~'''''"~j::_''-'l'",y REPLACEMENT CAR NO. No. ' 6'44006 MAKE-MODEL-YEAR-COLOR LICENse NUMBER ODOMETER IN ODOMETER OUT MILES DRIVEN GpS5 ~ '''''''''''''....,.Li,o".'' "":\6.56W" i. , gATE $ AY$ PER WEEK X ''''''''S PER EFFECTS RAGE (P.E.C.) '''''''', . iHIlW.S By my initi , accept or decline enrollm or Person Effects \mW.S _ - Cover . I accept, I understand and acknowledQ! coverage is DECLINES rates indicated and that I have read the certificate . ranee ACCEPTS ./ rnished by dealer prior to rental. . ( ~~ .' X RATE $ PER DAY $' PER WEEK X Sub-Total $ VEHICL~CON~IONt t '{\"( I_\~~E" CUSTOMER $ OUT r~I"A'\;-OI'n--.\-.e rll\, '(\,., '"' Cl( ~' INITIALS ~ $ IN ~~ ~_D Less Deposits $ RENTAL WILL BE PAID BY , , ~ ,^,',' , ''-_' ' , Net Amount Due $ 7C>~b ?:,;:~tJW ~~~,-. AllOWEIl CHARGEABI.E MILES ~ Mile. @ ,. Hours @ ~:.:. ~o Montt1sI~c.o Tolal TIme and Mileage Charges Ga. (Taxable) PHYSICAL DAMAGE WAIVER (NOT INSURANCE) Sub-Total __ Sales Tax or Surcharg~ ~ 2. ""h-, (J '!:')/i:iii..", "f ,Ii Gas (Nc1n-Taxatte) A).\-"V'llrl'lJ) CICOW (Non'Taxable) '- PERSONAL ACCIDENT INSURANCE Sub-Total PERSONAL EFFECTS COVERAGE ~, ':.J\cq~"~. '.,>;;.:;' '.>.,,~:U'u..;\ ','tjU .':;;-':,:~'~~" !~~$'f~ ~'Y\ '1B~~\ Db ~ETER \Riqn ~c')lB'rs'?' DATE AND TIME IN LI , .~ t ).:.. ":',., , '~ -,,~ OF, _-"'c_>> $ $ $ $ $ $ $ $ .~~ , , , , , , , $ $ $ $ $ ~~ -- -t- $ $ $ \ac Net Due Renier WARNING . I have read carefully, all drMng and use restrICtions O(l the l'8\I8fS8 side. . I am responsible for all traffic violations and must turn In all summonses upon retumofwhlcle, . I will report all accidentS immediately. $ : I have read both sides of this agreement and agree to its terms and conditions. I authorize you to process a crecliI card wucher, " any, in my name. TH"E.s \ 'lOUR INVOICE; , .' QU!;ON1NC' ECEL( '"' '" R""' .. "'r.;"f"""\',. ,.'.. .~ 'Jc.-' X ~ '-~"d.JnT'I\c.. 'In' ..""'l REHTER'S SIGNATURE ADDITIONAL CASH DEPOSIT DATE EXTEND TO $ ADDITIONAL CASH DEPOSIT CH~1f{: EXTEND TO FORM CFD.252 PA-4 M350) rmlll1.f727. AD D o(lllGll!SH7'lf FINAL CHARGES ARE SUBJECT TO AUDIT INITIALS DATE INITIALS CHE \. --r't ~ c FAONT "1.~"'\',",*iLH"",",,,d=~~~.-....~.........,,~ ,0 " . ...._,"""""""'= ~""M"" -"It- _ . 0_ RENTAL AGREEMENT EMPLOYER ADD~ C\\o4~"" '...\7':":\ PHONE EMPLOYER'S ADDR~SS CITY STA.TE ZIP REFERRED BY I will not under arlY circumstances surrender the use of the rented vehicle to any person other than those listed below or in Paragraph 6 on the back of this Agreement. Operation of the "ehicle by any driver in violation of Paragraph 6 is prohibited" If none, print NONE.cross this section. x '" "' '~_~__i""""""""","''''-""""'",~~j''~I,V;,,,,''''''''''"'-'''''''''''",,,,,~:m<iJ",",~~~,' '644280 MILES DRIVEN \1\B I72O,CaIlIoloPillo MECHANICS8UAG, Pol 17llS5 N (7l7jltl"B80 _'438 ' O~ _:~~AEPlACEMENTCARNO. MAKE.MODEL.YEAR-coLOR ( '''TY(\...;~....\ \M .-.z. ":1\~ATENc...' .' _ ,.- Z1PCOOE' UCENSENUMBER , tlRlYS\'s U':ENSE -,,?'. . .s:'~ - EXP. DATE ODOMETER 1"c;..1r ~ I\..\F '\_' '-r'I\ IN eli\OAj\ \ LJ I n SOCIAL SECURITY NO, t"\ '" J V- ~E1~.:. _ OOO~ETER lOCAL CONTRACT ''!I'! CAnNa. . , ~~~~"'~"'" ~ ~,'~\ (',c... ~ETEnJ 2DU-, L\ 40'iXi'ili~;;~': ~,~,\'t4,.~~~:e:'" OUT . lRlE:Lo DATE AND TI~IN A_U '& IIY J"...... Air. ".""",="',,, ~"..'.,.,'Our,..'.',,',."''''''''.., ." """.."""'.,,'""..........."", ii'" .,'~"~,.,, ALLOWED", - ,,', '""1' \J.-J.". 3:)OOfl" ,.,.'. . . """a:r.~LE <1> ".'" ,.C!I.'~, ",~". A.lot ,0, , '.' . . '. GAS OUT IN Miles @ -$ I ,i~I 1~4 ~:: 1 : ~ ty', : ~;f'Y~ .., WBBKn@ . C:CJ $ Rn--, IV'\ 1/ J' n -..,7 'NAt.fE .~..'k<1"'~~F.Na.,:~ ,'~'~~;~".."p 1/2 12 Months ~"^ $ , '11'1 ',A. II",\,\,U .....'\ ". "1:0\.''':/'''''/'' 3/4 3/4 T018ITlmeendMlleaneChames $ ~'"2..\ fV'.. DRIVER'S UCE , . \ l STA RY . """'RATION DATE ~ $' (')~ ( ~N p.. / / F F Gas (Taxabie) $: ~ . PHYSICAL DAMAGE WAIVER'fllOOl'~' 1)[ ;NES RAT~$ \~QS PERDAY~\.tbS PERWEEK XACCEPTS I By my In lials, I .accept or decline Physical Damage Waiver at the relte Ii,tpd above. If I decline to purchase the Waiver, I aCCjPJofyJL'jeJU:f6i)sibility tor loss by collision or Physical damage, regardless of cause up to $ ~ "'". /0 per DCaJrrence, which may be charged to my creelit card shown below. ccepting reduces my responsibility to $ D per occurrence, which may be 1harged to my creelit card shown below. PHYSICAL DAMAGE WAIVER IS NOT INSURANCE ~ PERSONAL ACCIDENT INSURANCE (P.A.I.) ~ By my initials, I accept or decline enrollment for Person Accid~ ~',: , 1~r1ce. "I accept, I understand and admowled~e that 'IS. DECLINES at the "i1tei...iI!dicated and that I have read the certifi Insurance ACCEPTS_ furnished by rior to rental. ~ PHYSICAL DAMAGE WAIVER (NOT INSURANCE) , Sub-Total Sales Tax or Surcharge /~t'/f) .:.,() ~ /}/ J i1lIlr.. '7L" G6s (Non.Taxd) ;!l FVf71lA.'1. CICOW (Non. Taxa6fe) '7 PERSONAL ACCIDENT INSURANCE RATE $ PER WEEK X ' Sub-Total ..""'" PERSONAL TS . RAGE (P.E.C.) RENTER1l INITIALS By my' initials, I t or decline enroll ~for Person Effects INITIALS Coverage. If I pt, I understand and acknowl at coverage Is PERSON CTS DECLINES at the ra ndicated and that I have read the certificate . surance ACCEPTS AL EFFE fur . by dealer prior to rental. COVERAGE X~ RATE $ PER OAY $ ~,* P~R WEEK IX'-.... Sub-Totti $ VEHIC!:!,CONDlTloN.t ,.., r'\. ~ ~~ "",\RE _'VSTOMER ~ $ OUT{". . A' "I"\\~ S ~$ IN ~. I 1'\JL. Less Deposits $ RENTALWlLLBEPAlPBY '_ - ". ~. ,'.~ c;:_ :"'.~,;. Net Amount Due $ ID~S DRC "UntO I ...nu' I am reJecllng uninsured mD10rIsl coverage under thle rental or lease agreement, and any poRcy 01 Insurance or ~If.insurence Issued under this agreement, for myself and all Qlher passen- gers of thle vehicle. Uninsured coverage protectS me end Qlher passengers In thle vehicle for loes and damages suffered If Injury Is caused by Ihe nagllgance 01 a driver who doee not have any Insurance to pay /or 108Il88 and damages. =~nT--.f\f\..(j LtJ I ---" . I I DATE TIME I AM04NT AUTHORIZED BY: AMEX CBlDINERS VISA '.'CO OTHER I CREDIT AUTH. NO. , , $ , , , $ <..1 'Z.. \ : l ) $ J $ ~I L $ )- $ $ I,....a'"":~ $ \ N;./."1 . U~ Net Due Renter WARNING . \ have read carefully all QfWing and use ~ on the <<W6fS6 side. . I am responsible lor all traffic violations and must turn In all summonses upon returnofvetJicIe, . I win report all accidents Immediately. FORM CFD.25Z PA.-4 ' (L-79350) l'tIl'IlIJ'-tm.AD"-U._",,,,,, .~ ./ FINAL CHARGES ARE SUBJECT TO Auurr I have read both sides of this agreemerrt and agree to Its terms and conditions. I authOrize you to process a credh card voucher, if any, In my name. I ~~.~\'O;;.:t~ENTD~~~~..;( ~~r' .............. RENTEA'S SN3~TURE EXTEND TO ADOtTtoNAL CASH PEPOSlT [WE $ EXTEND TO ADDITIONAL CASH DEPOSIT DATE , =-:?- CHECKED vu~ __~ \ $ lKlTlALS INITIALS CHECl<EDI~ I ~ FRONT ~ STANDARD RENTAL AGREEMENT BACK , '~~1."'R/>"I..D€.'F\1'\\5!9.n_~ ". "- "'-. ~.Pemai G"mo~_~ . me3f'~ the 'JenlCla rental tirm .;he.....n on the FRONT O'loe, whlfh ,$ an Indcpend$ll[O;;uly rental dca1er. !). - ~- me.ilns the p':lrson(s) s'gnJl"lg inls Al)rnernent. a:ny vlher person or "ntily LO which me charges ncurred under lhis Agreement dre to btl billed. and any Additional Remer shown on the FRONT of thIS agreemtmt ur otherwise permitted to jnve-!he Vehlcle with 'he writ!erl cor:senl of Daily Remal Compan'l. . ~ \I..\IJ)~g - ;Toeans th$ motor vahl<;le deS(;t1btlC vn the (rent ~ide 01 tt"lis Agreement ar.d lr1Gludes all tires, :ooJs, acceSSOl1es. equipm.:mt. KeY5 and vehicle <'::OCl.Jmenl!. ,1'1 or on the vehicle. d. ~'m(l 1 ()('-atIGn . 1'l<!a."I$ the Daiiy Renl-ai Company location shown <In (he front _;ide of thiS Agrel::rr.ent. RE~JTAL aFIIl='HICI c: ANn RE~!'>I!3!! ITY FOA PAYr,IE~Ji Darly rental company ag:'el!Slo rent Vehicle to Ren,er :3ublect l~ ail 01 ~he terms .and conditions on tNs pa~e and on front side whether printed ~r wntten, All ;;"ersons or ~nhlles wile <:m by dehnll:lon ,hot! Renter dre jOintly and selleral1y respo'1slble to D,~t:y R~nlaJ Ccl"pany tOl cnarges 1ue 'Jnder thiS Agreement. t~6IUBLQE:AQFl~~E'--!IC',-E RE;:.e.8!f1,~WARRANT"" DI'<;l:1 J.IMi'=!3 Vehli::!e is Daily Rental Company's pl'>:tDerty Ti",s Aqreemcnt tS il ccnlract only lor ;Jse of'.fej;,clc while Vehicle is on renl<lIIO Remer, .qe-n::ar.;r, <10l Cwlv Rema! Cornpanv-s age-n: or /:impiovee. nor is Renter's COf1c.h.l<..t under Daily Ranlal CorriP'aliy-s control. for any ::lurpose. Arty servlclil 10 or replacement of .,l part or .:lccessory to Vei'llcle dunr<l;j IOrltal must halla Dally Rantal Company'1J prior approvaL Renier ilcqu;res no (ll.';'1$ other that1 tef use Vehicle 'n aCtXlrc!anc~ "lith lh1s Agreement. Daily Rental Company MAKES NO WARRANTY .oF ANY KIND. NATURE OR DESCRIPTION. EXPRESS OR IMPLJEO FlEGARDING vEHICLE AN_O SPECIFlCAll Y DISCLAIMS ANY IMPLIED 'NAARANTIES OF MERCHANTABILITY OR FITNESS OF VEHICLE FOR ANY PARTlCUw;.R PURP'JSE. DIDly Rental _C:Jmpany -sh.iilln ...0 event bf:! responsible to A$1tet lor 3ny Indlre,,;t, special or COflSGquential darrrages in eonr.eC'Jcn wilh or a:rt$IlY,l out oj lumlshln;. pert"rm.anc~ or us", ot "'ehlcl~, !='lE;SPONS1BflITf FOR V~HIr.:LI;--C()NDIT10NiR1=:tURN;RFP{)'<;~FS'<;ION Renter shall return Vehicle to aaJ)y Rental Comparoy ,n same CQnclltion as recel'lleQ to fccallon -',\jhere rented or to <-uch ~callon a.s ~l tonh on fronr side on the due date specified, If Vehicle is nOI returned 10 such location by due ,:;late ior \'llthln 'hlrty (30) 1ayS c.-f co-mmencement wi rental. ....hichever js earlier). Daily Rental Ccmpanv marrec:oss!lss Vehicle <il any tim!: lhorallftQr at RenIer's expense. Douty'RenUll Company may re;::osSSS3 VE-hICi& d! any rlml'< ;hereal!er at F1el'ller's ~oen"!le, Daily Remal Company reserves Ih<1l ngr.l ,0 rep"&ScS%s Vet"trcle ,It :In., r,m€- W,!hOllt d~mand. C1! Rsnler"s e1<pense. If Vehicle is llJe<;laily oarkeo. used_ '01 :!ll 'lIega! purpose. :1 .)PPf.lr~n~,:, ,band4neo_ Renter waives prior rro!ice. prose_zure ~e<lrJnt;l 'lnd~_~lpt ':,~ II.ldic:al ;::mcass as a "nor condrlion to Dally gentaJ C.)mpany repossession. Renter .ac~~""1hat OMy Rental Gompany mav nolllv the piJ'ice -,,-r other authorities ih<ll the v<lhicle- is .,tolen Or'1';'lll1Si~g. aM Aenter wlilno: 110ld Datly Rental Comcb.n'~ or the <:lv,1 autholities res;:onsibl~ 101 lheir JC:Err;s. 10 f"lIXlSSess Veil'cis. :11 !he even; vi any Vehtcle replac6ment tur ol.oy reason, Daily Rem.,! Comp-atiy !l1l1Y. ell its option. termindle 1M; A!:;reem..n, and rent any replacemem VBhicle unoor Ih'l"teffilscl..:lneW,1C~(!em"'lll. I os~ OF,;R f')"'_M~JLIQ.....\LE~Y~I(';,",1 I)AUAG~ ~JP~ If Vehlc!e is 10$t <oJr dai'l"lag~a .,'vl";:la .~n fer>lal. ....n'~th-:lr 0' ,",et dUI! 10 A"'n!el's fault. Aent-!t s.h<dl\)a'l Dailv RefiiiJ Cc.mpany :;)n demi.l/'lc -the- dmoum !lI suell toss .::.r darna)je dt preVl.lilmq r'llall price plus Daily -R"mlal COM~ny-s relatli"J"'''CG:rn;e~.,nclu<jIr"!Qlosscfuse, ?-xcept"sl<)lIowa. '<\\T~EF,. :.l.;ret.cte 'S .,J.$<:oln accu:::!anc"" with .lit ~erms anr. ccncil'o,",S r,r Ill'S A9reem"r>:. Remer ", "ot resoOPSIO!e I'.lr Il1e:t ..li Ilehl;::le "r)iess ,t ,,; id! unatter-tad withouJ; ~I dOOl$ icckeu. 'Nind,;.ws \,p ',m::l f<l;;ysl'emovt!ll.. iblPHYSIG,:I.l OAr-.MGE. It Vehlde is used \n 3c<::<)rdance:- witt', all terms J.Ild conctl:ions :}i this AGf>;em"nt. i'Wr.lal~' ';I11!'Xlf"tSLO:I't', 'Jr -<:l~S "t or d.'W'H:l.QG 10 Venicle ar'.smQ Irem <,;ollis:ol'l or rOllover "it b;"e;; IIOrma:2V.~C; ~:,"'Jer~d "::omprenen~lve" lesses, -~ delertl11rT~d. dS :o;1ows (Il 11 RO!r.ter dQdires :~e Phvslcal :):;;mf.<ge Wal'ler ~ ~'1e :JlTte .;:f ren:tal by In:tlallng the b0"- Jacei.~ct pew uE;:::t...:~IED "l'lr-.t_:irs ~espons,t'lIiilv :; Jim:te,1 to OTIa:<,"'1~ aiTlouDlSat forth on flont.;ic.!e. -- j-" if R<tIl!P.'" ]cc~Pl:; Phll~lc.)f Dafl1aQ;e Waiver ,,1 Ume ct 1"r.!,:If ~V :n~ia1inq t)'Ie box ~t:el.;d POW ACCEPrED. .;l;~!'I"l1"lle$ponsit:lllt'i'~ furtr;",t re-dUCOO to l~Oj ,;,IT'ct.lI'lt set 10rt-:'1 I)n ,ne Irei'll ;;,de. PHYSICAL ;)A)\fAGE WAIVER :S OAJlY AE~JrAL COf.'IPANY'g 'NAIVER dR- PENTER'S Ri::SPCNSI8"IOTi iriS NOT iNSURANCE. - IF '/EHICl2'IS-USEO BY PERSCtJS OTHER TllAr-l PE~.rrER OR ;'NY APPROVED AD-DITICNAl RENTEFl. "JR 'S USED dY Tl-E PENTER CA AN'I'm-lE 'ElSE iN 'JIOL<l,T;C~J. CF THIS .;,GAF:E~,je:,-lDENrE.=i SHALL 8E P;ESP~NSI8L::. TO DAILY Ar::~AL ,:OMPANY FC,R ,:\U... LOSS "JI" OR C,AMAGE ri) VEHICLE 'JP i'a iTS FUL:..._ VAL-:-'E PLUS ANY INCIDENTAL RELo.TED :;05,5 i~;CUA?ED ~\I!~ETl1ER oq NOT RENTER HAS .\C::'E?TED PI-IYS1CAL _ DAMAGE vV,,"IVEf': ;-:-",OHIBlrED-1JSE::L"~I~_J;tlC,,:,,~ V",r-,ce ..nall NCT, Jnder J.rI'I drC'"cJm<;I,1ncas tm ttS<liJ for ;Ii'll' or- t.)I.....WI"':: .)'J!':JtlS~3 or "rider ,mv or '()ilO~~:ntl conlj,II'X1S. In.1 JIl'l ;,u~..., ~se .s WITHOUT uaii'f F1ental c:;;mp:iI;'-iFEar.lIS:::iGN: q' a" .". :ullt'l'illh"\.1 "1'<.:.mla:nll'.j ::.lllv"'1ental :urr,D,lny~ ..mtte,-.':un'>enl I\)\ 8;, ..l"".<-'r.a-l.<J'!j~r .~.;;e 2:5 .~I all dl"o'"cll<l-"'ho ,S '101 a qU.101tl~:; ;;nl:;! I:ccn;;ea (J1''1\i<r, .8y :,....,r;nJyw'lo!;e- ,-m.mt; :Jcensa n u"'" :::I,;,te 'Id.~ b2'~" 'fr'/clt~l'!.::r "u3p~nded .Nilhil" \~'l -m?'i:;)I.I$ ) 'l""'dr.t, ~ " ,...~ r,r ."he '-(')W ~Oo.sel>sGs ,I ',-,11,1 :Jr,v",( -_ 'C'l.,'~, ,To ,;,i:r, t1e');'IS or oroper:J ler h're. ,ncludmg '_ "I~l'Afeut -,:1.,;3'1'1' .......0\..1.;:11'1'<': SSMe€! . .Too,,;tJ'.:lI.X:;:.~ ,-,"'j Ve~I.;;le. :rader C)r other Cbl-"Ct. - -- .t'ln.'ri-.:;coi..!t"_s:"";r.:cnl(J!;L ,I' 1"_" i"y"~'pllrc'~,.,.';r~rr.[l"iss;,,n"'!i\cnme. ,rc. "~"'-~,, 'lI':I,,,,,,"nsp,, ;Jer~"n.... .:;pef!'1tlo.-'I m '.;<!h.C~2 .11 \/"""'. __n!~"".~"1 'rer" Dallv '~et'tal (;.ol""oanv tw Irau'j .): 7Ii$r;)'o-rl!!:>ent.r(l,lI'I, . ~ 1 r.." .1rr.- cer::;C!'.: ')in~, l!'I>UI .:l ..:a~"t~le-r ,-:'~,nC-lC\'t'~1'1 --;t '."I-'i<::"I , , 'i"n,j-,--~ ,'i!n.ck >:....",'K:t:'1:me.l :.lp"lC:TV ".. !""t;.,.~ ,~t~IIIo'" ",n',t'no;;(; m ,'h::.:;I'.{" 1)r IAh':!, ,nlV:";~"I\t" "ilil -:;:1..;::;20 0r ra. COliC.> "r ~<..I!): .1~Y 0tr"I (.l1~Y'~,'-;,;I.$I" ,r.el,,-li :';I.)(l,r,n,ml -:.' C;'1 ,'~".:I"",iV "it8~t" ..."-.8r ~ <:it: :v:o:\ ~'il'lmi". '!1e V(eM :::1.;- . .Int"":I'~na'-lV'-aU$I"'Jd.!r:'.l,;:,"IO::01 108';01 l'h<:!'v"J:icle. . ., ,0" ,)(h~' J:j'ffi,l oi p",.,e~ ..).:td vr ,-<faced ,m~ale Wold 0r C!:~,,,iWdY , '.I .In ilr> 'j"S<1l-~. ,~c~:,) "" 'Ire_oml" .'&tMl'lf1t. .'r ._.anton '",ar :.::11. 'TfC!~HH"q-,l ft.,lf'!'R;-;JW ... +3,~",i\,""rJ ,1 I.~~~,,! ,'-' _"In "tcc:ds",t ~ :'h.t "t;r')"t'~1'C3n'l.:J. ~!\Ji<lill..'tl 0: ,,~,s _r::'-,fis)C",Olot ""'dV bp In '<10.('....tl';1'I !:,.,U .. ':'~ ~'.cn <;.1 tn'., -ltC,"Io.I')(l"""~ "ccur'<KJ, ':'''':;';r;';}lrc;O-USE OF VEHICLE ..IOLArES ThiS AGf'lEEI,lE1r:-_ '/OIOS .AU.. LJP-8'IJ'T"'{ ...\ND 2T:-1E"" ''-J,>i~r'iCE -:ZY'CMA'.:.e: ':il-iE:,-l!:: :'ER:,,!-;"7;:::: Sr l.AV'I;:-',l..\KES '..'EHIC:..t 3U~JE'CT. ':~.W~::"ATE Mt-:-::~}'..'Ei'n 3" (},J.,LY "<l:~H...i.. .;.:)....<j.>_...~ '_ -'iGn::;''S7UvYAHD-.\lAKE::;- "'E'rrc::Fi: '~f:.SPG~~,S'~:";;;P. ...L. LOSS ':;F OR OAMiJ..CE -.: r.)q CC~jtJECj!:D WtTH iEF'IC..E, : ':I,,,,P[.'L ::-'is"T:-= -:::,WSE. tNCl ~r::;;"!G '3l,., .--lOT !_,~.II rED 7C OAll'! RE"iT,~L C,:tlPl',tJY'3 ~"(]-'I'"~,."';:~. -~:_!,;t:'.,I.'\J. i.OS5_ OF ....Sf:'. ':_i_:;'I~'',:;.'_~~ ,-~)_;;, ::'f"';;:F~r{[':: 2!_:f~Hrcu; 0.1,!-," .., 't""l";!! :;-.:ir-"P~"'l ::. 1'0t ms,lOo1nllP 'Y~t,t - '"".' .:.....,,.,, ,'h..',r, '..if~: .In_ ri'T'r. .;'1 ~';?r V_~",(:i~ .]r .'1 m.,. -:;],-. ::ld"-hi ':;~f-"U '_',.",;;.~,__." ~a_"~:':" ,~-=_":,-,,.~ c~;.;."IIb" .,[ 'r'...' L ,.._,-, .,~.~ ....1.1': ,.,..,...:~_ ,-,..'tT~'':~', ;,;. :~:,:rt'; -Ir"'l r-c<")\."",;;,; =.v,:-... '-i"'" "., _"'1'_~ ',.,. "".<'"1 'e:-.!' ,J' """'iJ.C:'!!!: Ht::r:--..:.'-', ~,~ ",. -;,j _.re ,,,,,. H.G,';'"I'. _,IHl . .1_$1;-;'" 't' II-:'s ;~;7~'r"(!I:t ..!:e ...1.:;:'00::' ~.ar.k' ,-l ',", :'"lS.'l::1 ;-lr,C: :!,':1I. _)r :~;'"I:~i "r ,,,,.r 1. '::-n>!'c,t -:-.:im .:lC~':1I:'_~J::"'8 ~o Da:i'l_~e,.,_!al n"'i,r: i ~ ,;vcn ':;<<'11I'r,~ 'l';_,'(.l~ '~l ;r.I-'o..;.'bli:! Si""emti!,; oJ_I ::!I:CiCB:-;O ,JCcnrdUi'C", _Mlh ~1S telms OT such atate~anl ",'invoice. CREDIT CAl'rD RENTER AJrH~Etil DAilY RENTAL CO!.1PAt:JV TO PROCES-S-. ~~EOIT CARD '/v1JCHER. iF APPllCABl.~~1'lJTEA'S NAME FOR CHANGES ANJ.:['~NS~~1.S TO _flESEFWATlON OF CREQIT Nil H ~ ISSUER- FOf:! AN AMOUNT EQUAL I":YEsnMATED CHARGES CUE. ~ 9 !;OMPUT A Tl0N OF CHARGES As provided in Paragraph i3 h.ereof, the A"nt'ilr ';GfEle-s tl) ~'{ to Dally Rent.:ll Company all chiw;es due 'n accordance wilh ihis Agro~m<;!1t at the requestor -Daily Rer;:aJ Company II A-,iii!i3r direCts Dally Rental Company to bill the .:;no:l.JQes (0 ilflother person or-company .'1/'10 or which lails ;0 make: payment ut'on being biltad. iI'e Amlter-w,fI f~av the cl'1ar~es upon demand of Daily Rental Company. Dally Rental Ccmpill1Y ,ray l.;eep ~ny sccunty :.lepo~lIt proVided on ,he FRONT ,)1 thIS Agreement 10 CO'l€!f ot"'y ,;;ha,,;as or Olher liability .vhlCh Daily Rantal Company belle\J~ .Nflrr.:mu;. Ihe rBlenllon of th6 ~eposlt The charges nenlerwlll pay Indudebut.1re not:muted to, . (i! lTIME AND MilEAGE CHARGES:-Rer;:er will pay Dally Renlal Company far the number of miles dTlven and the Ilme_ vehicle is 'anted ,It the r<lle~ sho....n on tl':e FRCr<jT ,:,f lhls Agreement. The 11umbei -';'1 miles '.'IoIt oe determined by reading ;.I'\e Ia<;;wry_ installee odome!et_ nente: will not d.etach !he ..;.dome:er und If the seal,:;; broken, Renter chatl pay for ;ts replacement or repair aroe a mileage .marge ~qt.:l\lalenl 10 lh:fl av~roJ<:;'o milcag~ Jevelopoo :r'Om me e,>tp",ri<<ne.!l ot Dally "':enta! C.)mpany (b jPHYSlCAL DAMAGES -WAIVER ,PDW)_ CHARGES: ,t J.ppilc<lbie. cCrl1p'~le-j ..I da,ly -charge set forth on frO,.,1 side, Daily charge IS due lor eac1( full or partial Rent.il Day: (c ,PERSONAL ACCIDENT INSURAt:JCE_ (PAl) and PERSmjAL ~FFFC,,:; r:O\:~RAGE (PEe) CHARGES. if Afwicabl<l. oomot..:ed al daily .:hanj* ::wt forth Uti FRG-NT Jldr.. DaIIY'- charge is due tor each tull or ~arllal rental day. TI'ese are op:;cna.1 inSUI'<H,c,n:cverage!_ Cer:rlicale 01' SUmm3f'")1 descnblng benefits and .:X(;lusions .$ availaole--'tt ~n1I"q 1(j(;..tIOO. ( d )T AXES; ApplICable- sales. use- and excls~ taxes and aroy amounts chal9~d hy O~il' R(lntdl Cornoal'lyas reimbursement for taxes paid; r e lFl~JES MJD On~ER EXPENSES; Fines. :>anaities. k:rfellures, .~ourt ,-,~'sts ,1lnd .,thar -GXl:enses that ma;, be-jSscssed aga.inst Da.lly RCI1I<:lI Company Wr>ICI1 Mil' due DV mason ill fler,ter's possession or I.Jse of Vehlcle_ ,nclUdlng !r;J!fIc anc ;:larl\lflg rilles, [ f ICOLLE.C,ION AND VEHICLE RECCI/ERY EXPENSES, Dalty Rent:!1 C0rrpany's COSt5~ in<:!uding reason::!blot attcmey's fees_ inc;J:Tp.d in collecllnt;l charge$ due 1,(,11'1 Renter piJrsuam to th,s Agreement .,r In rscov'lrin9 '.fehicl& wc,ich has been Olbandoned ~V R8r.ter OJ' sei2:ed by Clove-mmerltal allthGrlly as a 'e~uJt ()j RenrMS ac~bll~ -~ I. 9 iINTEREST' eN PAst DUE-..\MOUNTS al the rate Q: 2""~ p$-r ;1':onth, .:Jhic~ ,f :"1~! (.laid <s adde.:J 10 th.. balance .me! is subject to ;;'\:llr6,,1. ~LL CH~.PGES ARE 3lJ8JECT TO AUD:T, If. U~Qr. auolt, an error is, round. Credit Cure RanLer a-ut/':Drizas Da;ly 8en:al Company '0 C0rr8Ct such cnarges, inclw,jlnq changing any ct>arge ;:ard invoices S1~ed 0'1 Renter. to ,ellect corre:.:t c.'l..:gas. 'i/lth ,"<ltlen nOlice of ootl'i!lCtion :0 Renter. _ _ 1 0 lli!BtL.eAan.:..w.~..,.. PR:6TE(;710~~ Af!Y~no 3UlhQn~&'j by thiS -"9relimnm to driv", . Vehicle :8 covered bv an automobile l:al);:''Y :nslirance po;,CV ,'Il..GAINST lIA6Ilt..' m THIRD P~'RT:E5 ':)NlY (NOT INCLUDING. TO EXTENT PEFn;.JrTTED S'f L.A.vII "'NY Or SUCH ORIVER.S FAMILY MEMBERS RELATED BY SLO":,u. MAGRIAG;:;' C~ _'IQOPTfCoN AF-,'3.1i)lr~G IN THEIA HOUSEHOLDj, [or I:OOI:Y ":UI'". <:le-alh flr _,;r:.;r)aor:y ~,,;;,_~.,; ,",\\J~e,j by :Jr ansmc 'rom LJ'Se or opefilllOfl <)f '/Flhlcle ..5 permItted oy ;I'",~ AgrG'!ir1'!e'll. ,"~ ::ifl'\ount ,}f co~ra;e prC'lld~d I.:ndet :1'\1$ Aqre.;.rnent '$ aqual ,0 [M mlfllmum finar~,~1 eso',)f'lS:bJH~/I;mits estabh"h€d bv the fiGanc:al Res+ro!'TSlc;litv law or ..':~er .11?JJ'ir:abl" :<tlc,l1l.1e- ;"SWtu:vv Llrr,:r,;1 ,)r- lhe .J~'a Jr o:her junsdic:Jon-:n whlcil Vel1ic_e ..'12$ rt!nW;j~ ?:-ete<e:lc;rl ....ltIeu.'d2r ';~,'!l i;,j:l1m.J.~:caiiv ~ontolm '0 b~Je'Q:.Jlrsme~13 vr ..ny 'nan-::attlr/ ~,o ~<iU;," /a,', .Il,cll ,"l'I;2y ~~ appli<.ao'e. BUT OGES ~lOT -;NC'~VOE 'UNlc-1SUAEIJ ~.,;C70RIST_' 'UNCER1f;lSURED_ ~ACTOj:llsr GR SUPP!..E"IENTARY --;<{O l"AUlT' OR On-iER O?TICrQAl PROTECTiON ANY CAllY RENTAL COMP-'\NY AND RENTER h'ERE3Y REJE,:T, TO E}(TEr~r PERMITTED BY LAW. INCLUSION OF Af-JY SUCH pqOTECY<ON. In tM '.Wf'nl t~...t ~""\;""?(!~_ i$ Imr.:c}Seo. hy oper3tlon of )a'N. Jor bell~l;t ':If any ~rson "ther 'ha1'l Pemer. :r>en :rr.13 (,t ,>uch co'teTar,:;e shaif be Sta!ufcry L'mits ':il state -:lrclheriunsdi~lo'l '., wh<<::h 3Cl';:dent..:c<;.:rrlW. Oillly ::'I0nl31 CVmpany ....arrarrrs th<ii 10 the- ex;e-:! jJ"lrm.ttt:{! ty lu.JJ llaoi!ity ;;>iolc...:tk,l _\l x..rbed 11 ll"1I~P.'U'a.gt;wh 10 Il'i p!1murf .viI/': r&SP'?<.-~'f)- ;)tll' 'lSI;r;lI1,~ 'wwi:mli! ~o R~ni',". 1'Jhter::md ~d(/ilicf',<l Ren:er[~l hp,:'etL Inderr:nit'l 0l!"1:;! ho'.'. aill::; I'lental Comp@n'l, ,IS d~lil'll\', ,Inti l3lllr.~ovqes harmless rrorn JDd ag2:ln<;! all I)'SS_ hacJllty _~r.d l;'> pens" W""'-fScc,..er .n cl'XC<lSS of _ ~;mlts 01 :,ablillY ptotec~lGn provi~ed ler ~.ereln...ls d -eSI.oJI 01 bDdilV ,nIUt""l, 'b?c>:h .',t'orcIJo)nv (!<'tt'r'-Ilae .~use<:l by. 0' ariSing 110m -~se ~ t'Jpf'r.'-:ri':n .)1 .'<;h;c!e PP.OTEc-TI(;t'1 IS VCID ,~~ MEXtCO Renter mU$l obtairo Dal'v R~~'ai G<-':'l1pan'l$ ':Jrille,l <tulhon~"totl )J1<j ~urCl1<>Sa iitlbr!ll'l ;'1'10 orop.~rty damaqe ,nst.:f2l1c:; ce;lc(~ .51::;:1Ii;\0) McXI;:o. 'F :RENTER :.;;E3 lJQ7 REPOP'" A'CCfDEN7 "'0 DAll~' oE"JTAL COI.1Pl\NY WiTHj0:.__2~ rC'l.rrS - 121" OCCliRRENCE. L!A51L1T'rlNSUF1ANCE :'::VERAGE OF-SCRI8E!) ;:>l-rfl-3 ."~R;'l~R,,",H ici Ve,D _NO DAilY RE-~iT~L ;::Or'IlPMU ?QOVICe.S j,O '-iM;;LiT<' '~J$iJP"'k'~ ~':. _:;!::~-jr!;.R UNDER ThIS ;'GREEi'.:E:'iT 1 t .RM~JF ;.,C..."tot;Nr::l ":'i~D ?ol.e.&tlfc ,)R TM,!.FF';: "IC'_..:.Tt'J_;--lS ~":n!"I~ ~J,,,I~ prom!J;i~ :ecort all -lCCiC<!r::3 invoiv:ng Ver,ct& te ::<111, 1":l",nlJ! -;.;..Wy.,.,',-, 'I'.;! .,; ,...C:. '. ~ .....or''''.. and Aooll;tllli11 Rlmtsrls) shall -Ja-iLv.;r 10 D-?'t1\1 R~,-'t<<1 C,~ml),lrw ." ~d(")(S )1 _In': '.'"10 ("!<:;{c'\.>ICl by ~uch party ,,,,Iating 10 '::r':Y'S\iCh .lc:::iderH_ Rentel ,wd ..:..n-(.Ii~I;}":r:1 RanTan.:;; ,y,1I ~';"Co,ii,ue 'U:iy With D<1l:y Remal ~l'Ip~ny .:1 :;o.TI~ra::n;:; "c(:id;inll_ep~"$ ,UI;;! '1 "1';'~'st,g.:\t'<J-~ 'i!'? oj..:1,"'I~e .;i anji eTai:",-?; r3\NSliirceHt:r<;l ro:\-"n'l ,;ucf> 1':CI-::.,f1' In,,_ 1\':1"'t;(,;::.) :,,:t"{ l",,!_~, .;;;_'T".'1f''I:? oblai!" ;~om .jr.v qC"'<1t1"m~r1lal o.(::1':;)rll'l .. ,,"Inr.; j"'S~:,-'i"n :h",rc,,,t -,11'1 ')'-;' _, '; 'r" ",!,ll",:l :58ued l.satl.tSLlIt",,:u:w....ci'l<.lccidel11. 1 2: PARXtt,G ~ND rPAFEll:;.2L!Qkf.T1C.t:t~ RenIer _-1';111 ~ r,:;"'C_t'''\.'''t>,,, hr .1r" "1'(1 -,I, ,yd.,f'<1 ,;nd :mlt:c .;.ol<lr:cn fines -,lnd ~enaltiGS ,J.nSIr>g ,;,.t (.1' ,~-(O <;I' .)cer~:;'m :'If './')~,. :101 "nrrr::; ..,,. pi1rtcd or' .t1f;' ..".":ai .:vJoj agree!> '0 ~y or idsrnr.ll, -,r>d "c'j Oa:l:l q"n:iiu WI'I;~-w"~ <,J".,',l.'s ,I.... ;venl Daiiy R&nl8.1 ':;-omp>lny uays 5UcFI-!iite5---.'jI'~r-;:iell..lili~.s .;n J!lll,;"t ): .'-'!..:"(;'r. .lf1c; ';;' ,...'rr.bt,!l\It O,;,jy3:9ntal Compa<ly i,\r lll,ts ':i)I',}c~;or :;.nd .;:,r.,), ..>>.;)r",;,~s :,'d:"..:inrl ltt';-"~: .~,-,.l -(:;-,ti"'g I') ~,i-i'l"''? A~..,r"r "rd A<.lwllon,,1 Qel'll;]r\Sj ,,~tt\o!.,,;; 0,,1'\' r:k-",i '=-C:fT",~".1r',.. 'T; ,;0_~1',.,w.():, Wllh ::I'1'I';"fl'; JQlflt,OI1:l <)1 j.l,ifkil'l~ or ~Iatfi:; la."s 'tIlSITl'J ~ul." ',~>i ,.r ,Ji>.ft:u,.,;n "1 "'-';;1,-. r''t 14","':",r ::~~;-~:,~~::,~:~~f ~~:';~~~.~~;~I;;~:;I<'~~:b';:~e~ ,~~ -;~7. .uJ:~\i!>::;~;'~~:;: ,;;':;~:[Sl..,;~~;~~;~ D.J,l~ <,=o;nal C,~,"'pi)r,y hi!; _,1'1 ,!:; pOSSE'ss,.;,... - , ~,1$9lG.I,.t.1E~.D: Tow> -'l!;;~6-r;wm ,In:: J~ c ~ .),]1'-'')1 .:;! .i~: -..~ofG :r ""~r-s'_"-""'; 'v-,R",r'ter R~"je-' .::-"""aH"-~ respO~H,CH? regard1e~~ ":'1 :J.~_'I .1.'t" 1'"'(,:ec .iSS ~!"""'<JI ,r. 1..1. W~I'.l~'!ld.QP.!8'"ATiQN__OE.......mt~1.~-f.l;'.,,~.l.!';E r:~'8- 'qr..a"'e~l "; .b~ ,1f,[.'" ,qrr:ar:-.llr.t b';_~_-:;;' ,'~:~~"~~~r :~i;;' ;:.~t~.~~~~;~r-~~~;:,:'~:_~~t .:,:~~;~~':!:~~~::.:~:si7)' :~.. ~';~::,''j;:,~~:i :,: :\:~~ ~'Jr~~:;~~~'[~:~;i1I~'~.;;~~'l~~ :;~J~~~::~~'::~ :..~.,,~.~;:~ ~;~:~~~,~:;,';,i'.:,_. '.~-', ...:~_~1;L:~'J:Q. '-." 'J-3, "'.'t'lnl ~cmP..t'-1 ~'lrjlV liRtH''':' ;';' "'1 ,c~N ~ -,',;e -o-~-.lc'. ~" - 'u.e>i ' r ,,'.cJ ~rr>f1I';y"es Ir;:."" ,lilY; }"fy;n,.-c. -: to :'1,..,,:.,1' ~~ ~ _ ~'J' -:'''1 r.;.'. :0;-.."'''11.,', ~~~.~~'.~_':~ :::~~~~~:f1~~~.;~:.~~;;~i~~:, ~'" J; :i:~},~.~:~,~:._:,i~"irv 1~ J..l:E"~~'; ':.'"~.,,~ "A' ,,".'r";- ! 5 1:l..0J-ii~...:.,~ 1f ..ny ;:;rc,,- ';;.')i"- -c-f :h;~ ;,;r',:m(.r~ S. ')'c!'"i!bl'(.'(~ Cly :<1"1. r .gl.~'l ~.ot ,'1'>'::::1'" re-l1'\dlrmQprC'J15Icns. " , ' ,~ - ~---.;. --, , -'~" ,C-,_ - ',",,---, -~. . ,," ,,,,en :1 ,-~ 'I t .. CUMBERLAND VALLEY MOTORS, INC. Plaintiff : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION GLENN NESTER AND ASSOCIATES, NO. 00-6481 INC., GLENN F. NESTER and SHERRI A. NESTER Defendants : JURY TRIAL DEMANDED PRAECIPE TO ENTER JUDGMENT OF DEFAULT TO THE PROTHONOTARY: Please enter Judgement of Default in favor of Plaintiff Cumberland Valley Motors, Inc. and against the Defendants Glenn Nester and Associates, Inc., Glenn F. Nester and Sherri A. Nester, for Defendants' failure to file a response to Plaintiffs Complaint after they received the required notice. Plaintiff is requesting the arnount of $37,991.05 together with costs and interest at six (6%) percent per annurn from the date of the judgment. As required by Pa. R.C.P. Rule 237.l(a)(2), attached as Exhibit "A" is a Certification that written Notice ofIntention to File this Praecipe was sent to said Defendant. METTE, EVANS & WOODSIDE By: F. Yani e , Esquire . Ct. No. 41 3401 North Front Street P. O. Box 5950 Harrisburg, PA 17110-0950 (717) 232-5000 Attorneys for Plaintiff, Cumberland Valley Motors, Inc. DATE: January 12, 2001 -., "- -~.,' '".-.,..- _'CH . j,". "'1' - CERTIFICATE OF SERVICE I certifY that I am this day serving a copy of the foregoing document upon the persons and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States Mail, Harrisburg, Pennsylvania, with first-class postage, prepaid, as follows: Glenn Nester and Associates, Inc. 1029 North Lake Park Avenue Carolina Beach, NC 28428 Glenn F. nester 1080 St. Joseph Street Apartment 2-F Carolina Be1ach, NC 28428 Sherri A. Nester 1080 St. Joseph Street Apartment 2-F Carolina Beach, NC 28428 METTE, EVANS & WOODSIDE By: Attorneys for Plaintiff, Cumberland Valley Motors, Inc. DATE: January 12, 2001 :248344 _1 I . '"", , " J" .,C;, " ., "","..;" ,.~:' 'k~ ,.., - >'-~';,,- --^"~ ""~'W ,"", .'- - ~ ~ t~ :-a & 0 0 g " -n - rP s: '- --~\ r ~ '"OOJ "'" ~~:!J rnm Z ' '~ r Z'::D -1--:t'r1 21:;;; ~~~'Q Q':l4':... w ~) . ~ ~ ~6 c,,(? "'" ~I:-n Qr ~ ~, :l~ ',=!{~ - -J:- ~8 'P. cSfn t:)- .Pc: ~ ~ => A, 0 -< ~-, j I i ~ ~ I !~ l,l,' 11 ffi I """. ,.-,_-1".-. -- ",,'-0',','. '_" .'d,;-__.', "_",,. __.'" "-0<;\;;---,_"'-'-' .--"V- C,-,,'-, "~'::, ~~ '-",; ~ . CUMBERLAND VALLEY MOTORS, INC. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff v. CML ACTION GLENN NESTER AND ASSOCIATES, INC., GLENN F. NESTER and SHERRI A. NESTER Defendants JURY TRIAL DEMANDED RETURN OF SERVICE I, Margaret L. Boyd, a cornpetent adult, not a party to this action, served a Complaint on Defendants Glenn Nester and Associates, Inc., Glenn F. Nester and Sherri A. Nester by certified mail, return receipt requested on September 26, 2000. The Complaints were accepted by Glenn Nester as indicated by the green return receipt card attached to this affidavit. The Defendants were served at their place of business in North Carolina pursuant to Pennsylvania Rules of Civil Procedure Rule 403, SERVICE BY MAIL, and accepted on September 28, 2000, as indicated by the green return receipt card attached. In accordance with Rule 403, service was cornplete on Septernber 28, 2000, upon receipt of the mail. ~h~ Maret L. Boyd Sworn to and subscribed before me this ~ day OfJ""'"Y'20~, . YI;~;f hV/>J<- Notarf 'c My Commission Expires: Notarial Seal Joyce A. Gizinski, Notary Public SUl!Quehanna Twp., Dauphin County My Commission Expires Nov. 10, 2003 Member, PennsvtvamaAssocrationofNotaries :248829 _1 :i,'"" , 1-." ., 'i,i IIHJ ,._____..d'.,. c', I J...., '~ '.-l', ..., _ ... ~. ~."o~","_ ,~. "~" I' I, "", ,"ij'lJ'liIi,lWi,u"ii,,;'li-u,1 . 1 ' ._,!,,,L""'iil~~.;u'l~l~~~III,;,.,.j..1 1.,._... '. ':.:"I:',ijb,hol"'j',.:ol"""'i'."'::....",......,,,,. "',I "U.,'-.,II,'I, ""1.""'11I_ ,.,1 ,'", "".. .",,,,, ~~-, . - ..,. 0 0 0 C -n f~ '- -~ :1:>0 :L:n rn :z rtlr_ ;;U ~;g .~ \D .-c'''', :0<2:: ,-... r:::t:J > ::';:!:fj :;::: ~8 :x t'i~ z >c: I.C 0 .. ?6 ~ 0 <::> -< . Li 1 ~ '1 " 1 ~ fl t I'; , tJ ,. . - _.~ . > ~ . ~-' "' -,- , ~ CUMBERLAND VALLEY MOTORS, INC. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff v. CML ACTION GLENN NESTER AND ASSOCIATES, INC., GLENN F. NESTER and SHERRI A. NESTER Defendants JURY TRIAL DEMANDED 10-DAY NOTICE OF INTENTION TO TAKE DEFAULT JUDGMENT Date: May 31, 2000 TO: Glenn Nester and Associates, 1nc. 1029 North Lake Park Avenue Carolina Beach, NC 28428 Glenn F. nester 1080 St. Joseph Street Apartment 2-F Carolina Beach, NC 28428 Sherri A. Nester 1080 St. Joseph Street Apartment 2-F Carolina Beach, NC 28428 YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO TAKE ACTION REQUIRED OF YOU IN TillS CASE. UNLESS YOU ACT WITHIN TEN (10) DAYS FROM THE DATE OF THIS NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING, AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE TillS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOWTO FIND OUT WHERE YOU CAN GET LEGAL HELP. DAUPHIN COUNTY LAWYER REFERRAL SERVICE 213 North Front Street Harrisburg, P A 17101 (717) 232-7536 METrE, EVANS & WOODSIDE By: Jo F. Yanin , Esquire Sup. Ct. No. 55741 3401 North Front Street P. O. Box 5950 Harrisburg, P A 17110-0950 (717) 232-5000 Attorneys for Plaintiff, Cumberland Valley Motors, Inc. DATE: December 13, 2000 - ~~ ,~~ "~ ~ t-:;,., . CERTIFICATE OF SERVICE I certify that I am this day serving a copy of the foregoing document upon the persons and in the manner indicated below, which service satisfies the requirements ofthe Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States Mail, Harrisburg, Pennsylvania, with first-class postage, prepaid, as follows: Glenn Nester and Associates, Inc. 1029 North Lake Park Avenue Carolina Beach, NC 28428 Glenn F. nester 1080 St. Joseph Street Apartrnent 2-F Carolina Beach, NC 28428 Sherri A. Nester 1080 St. Joseph Street Apartment 2-F Carolina Beach, NC 28428 METrE, EVANS & WOODSIDE By: J. n F. Ya mek, Esquire up. Ct. LD. #55741 3401 North Front Street P. O. Box 5950 Harrisburg, PA 17110-0950 (717) 232-5000 Attorneys for Plaintiff, Curnberland Valley Motors, Inc. DATE: December 13, 2000 ":2lFi651 _1 ~,~. , , "'~H.iL "1 IIlDlW ~$~iiUl!ia~.l!t~'i;~~~;milcl-'iH~~r~;;\ _ ~, <or. ,~_". ,,~,. _,~_, " .. . ",. ,~ '- "' ',~ H " " -, ~ ~~ ~c liIw. -~ ~~ ",. ."""," '.~ "', ~ () 0 ;;;?, c: s:: C- --I !!R :Do ~ Z ;~~ "TI ""F t;;: --:--JfTl ~.- \D :'tiC? 6 Ch"j ~ :I> ::r-r; -OJ ~~ 3: ~F? '-e 0' --I 0 ~ 0 ,~