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United Truck Rental and Equipment Leasing, Inc

Cash Profile Application - For Rental Use Only

Print Form - Fill Out

Last Name___________________________            First Name_________________________        MI____________

Home Street Address__________________________________________________________________________

City________________________        State___________________        Zipcode____________________________

Own______________        Rent________________

Social Security Number:______________________        Phone Number________________ mobile # Not Acceptable

As a reference if you are renting please include your landlords name and phone number________________________________

Name of Employer____________________________________________________________________________________

Street Address______________________________________________________________________________________

City_______________________        State______________        Zipcode_______________________________

Phone_______________________    Contact Name___________________________________________________

Application must be accompanied by 2 current utility bills and address must match renter's profile.

Valid drivers license (If out of country drivers license - valid passport must be available w/International Drivers License)

A refundable deposit of $300 must be made in addition to the rental of vehicle.

The deposit must remain in tact and cannot be used for payment of rental.

_______ I acknowledge that I must remain current on all payments due to United Truck Rental for the Time/Mileage and any additional service I elect to purchase under this agreement.

____________________________________________________________________________________

Customer Signature

RA#_____________________________________________