EmailMe Form - Corporate Account Update Form

Date *

MM / DD / YYYY

Company Legal Name *

Trade Name/DBA

Federal Tax Classification *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Web Site

Federal Tax ID / EIN # *

Dunn & Bradstreet #

COMPANY DETAILS

Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Accounts Payable Contact *

First Last

Accounts Payable Email *

Phone *

### - ### - ####

Person(s) Authorized to Order Vehicles *

Person(s) authorized to order / rent vehicles under this account.

Person(s) Authorized to Modify Account

Person(s) who can change / modify information on this account.

P.O Required *

Yes

No

If YES:

Fax

Verbal

E-Mail

Telematics *

PV Rentals, LLC. can provide access to the vehicle Telematics system, which provides real-time and historical vehicle location information, mileage, driver safety information including speed, seatbelt use, etc. Telematics access is only available on long term rentals of 30 days or more. Telematic access is $25 per vehicle, per month.

COVERAGES

For Rental Contracts: PV Rentals offers optional waiver / insurance / products for additional fees. Please select below whether you accept or decline each product. Charges will be added to every Rental Agreement rented by your company. Pricing & Product Brochures are available from your Account Manager and at the counter.

Loss Damage Waiver (LDW) *

Waives our right to collect for damages done to the rental vehicle while operated according to the Rental Agreement Terms & Conditions.

Rental Liability Insurance (RLI) *

RLI protects you against claims made by a third party for "bodily injury" and/or "property damage" sustained as a result of an accident while you are operating the rental vehicle up to the minimum financial responsibility limits of the state in which the vehicle is licensed. This coverage is primary insurance. RLI does not cover all situations that may arise while operating a rental vehicle.

Personal Accident Insurance (PAI) *

Provides accidental medical & death coverage for the renter both in & out of the vehicle & passengers in the vehicle. PAI does not cover all situations that may rise to death and/or medical expenses.

Supplemental Liability Insurance (SLI) *

SLI protects you against claims made by a third party for "bodily injury" and/or "property damage" sustained as a result of an accident while you are operating the rental vehicle up to $1,000,000. This coverage is excess over the "underlying insurance" specified with your signed rental agreement. SLI does not cover all situations that may arise while operating a rental vehicle.

Platepass *

Allows unlimited use of all toll roads in the State of Texas.

Certificate of Insurance

If LDW & RLI are not accepted above, an updated Certificate of Insurance naming PV Rentals LLC as a certificate holder must be provided.

NET 30 Payment Terms on Direct Bill Accounts

Officer Name:

First Last

Title

Officer's Phone

### - ### - ####

Officer's Email

Print Name:

Title:

Phone

### - ### - ####

Acknowledgement

I/we understand that this information has been provided in order that I/we may obtain a Corporate Account from PV Rentals, LLC. I/we do hereby authorize PV Rentals, LLC to investigate the credit history of my/our firm. I/we further agree that the terms of this account are NET 30 after Invoice Date & that the maximum interest allowed shall be charged on any unpaid balances. Venue for this account is Houston, Harris County, TX. I/we understand that by requesting a credit account, I/we agree to abide by the TERMS stated herein.

Print Name: *

Title: *

Signature & Date: *

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