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<br />LESSOR:HERTZSy"'SM MEMBER ^ RENTALAGREEMENTNUMBER~' <br />r~] RC~IGE'S TRUCI( &_f1R RC•NTAL SERUICE ~ L.T - 751.254 <br />195 COMIAERCIAL STREET S.E. ^ Insurance PLEASE BE SURE TOSHOW THIS <br />Cetlilicale On <br />~ SALEM, OR 97301 File NUMBER ON ALL CORRESPONDENCE <br />HERTZSYSTEM,ING r r <br />( <br />03) <br />81 <br />4466 wiEncEOErEn~,~n~conrn@nqvcmctonroow.~ErEnon <br />. <br />~ <br />~ <br />• u~atoeuivwsraueoHUeoooueien <br /> DO NOT Sf IO W tENTH$ <br />•- ~ •• • • <br /> • • <br />• <br />TOBEPAIDBY:~CFNRGECMDIMPRINTHEqE) CfUwGECMO ~MOUNT CpE0linPVqOVN.NO. ~ i ) <br />~ <br />~ ~ <br /> <br />~ $ MILEAGEIN ; <br />j <br />i <br />' <br />~ i <br />i <br />//~/ <br />~ // <br />~ J /' <br />~ cusror.~EnwapinsEOaoEnr~o. <br />s oaiE MILEAGEOUT , ~ '~;` <br /> <br />°~ <br />~ <br />~ Iri orl C~~Ur! <br />- ~rK / <br />/ ~ ` <br />~ ~ ~ <br />~ <br /> COMPaNYNpME MILESDRIVEN ~ ~ ~ i ' <br />i ~ i i <br /> <br />oaiGiNUwnNO. PqEVroUSrVnr+o. ~ <br />MILESALLOWED ~ ~ .~ ~ i <br /> ~ <br />~ ~ ~ 1 ~ ~ ~ ~ r <br /> . <br /> ~ ~ ~ . ~ MILES CHARGED i ~ i ~ ~ <br />i i i i <br /> COMPANYNAME~PLEASEPRINT) SOGSEC.NO. ~ ~ i <br />~ I- I I I-) I I I REFpIG. HRS. END i ~ i ~ ~ <br /> <br />m~ <br />S7REE7 <br />PHONE No. i <br />REFRIG. HRS. BEGIN ~ ; i ; i <br /> ~ ~ ° ( <br />~ ~ i i ~ i <br /> . I A+o i e r~yi <br />TIME <br /> ITY/5 ATElLI - . - <br />qnt <br />M C ~ <br />( <br /> <br />G ` CUSTOMERACCAUMNO. _. l <br />, <br /> ~ <br />~ E -f <br />D <br />P" <br />nMe u <br />6ui_ <br />z STPEET/CM T~TE21P ~ ~ <br />= <br />N <br />pM <br />o <br />~ <br />S <br /> TIM ~n( ~ ~iME ~ =! <br />W <br /> <br />Dfl 'S AME <br />PLE <br />' <br />' pµ <br /> ~ <br />EPHI ) <br />SNAME <br />ADD <br />LDPNER <br />p ~ <br />~ <br />f' • ~ • •f • <br />~ ( <br />I ORNEfl'SLIC NS[ O. CLASS STAT E%P TIO DATE LOCALCHARGES i <br />E <br />~ l~ ~ G c' <br />~ ~ AY `15 PER <br />' D^Y ~ <br /> <br />AOD'L DR ER'S LICE' SE NQ <br />ClASS STA E XPIMTION DATE ~ 4' <br />~ <br /> ~ E%TM CQ PEfl ~ <br /> HRS j Hfl i <br /> • ~ ~ • ~ - ~ ~ ~ pEq <br />EEKS ~ <br />VEH MAENO. LI NO. STATE M / 90pY$IZE VE111CLEHEIGHI ~~~ ~~ <br />I I I I • S a G~1~ !/ ' ' LE <br />M° Es ~z <br />t~G <br />MNCPAYL M i <br /> HANOTRUGKNO. OiHEA <br /> ~ ~ SUBTOTAL ~ <br />CONTPACTSUPPORT ^ IMEHIM ^ ADDITIONAI GUARANTEED DTNpEQUINED i <br /> MILEAGESGHEDUIE i <br />^ SUBSIITUTE FOR VEHIGIE NO ^ Y <br />. ES ^ Np ^ YES ^ Np i~ . <br />- SUBTOTA~ , <br />~N E <br />OUT E Ye % 8e ~yi ~~% FUEL <br />Ye '/. ~'e '/z i6 ~ % F i <br />OUANTI7Y <br /> HANDtpUCK DAYS @ pAq i <br />,, . .. C ~ <br />LIMITEDLOSSANDDAMAGEWAIVERILDWI Paos DAYS @ pAy i <br /> <br />Cuslomer shall relum Vehltle lo Lessar in Ihe ume mnQlion as recelved, ord'nary wear eaceplN.I1 VehMle is used wilh i <br />Lessor's permissbn and on Ihe lerms sel Imlh In <br />paragraphs 5, 6, ], 9, 10, 8 I l on revarse sMe,aM suslains tlamage <br />OTHEfl EpUIPMENT <br />UAYS ~ <br />' <br />, <br />Cuslomer'sresponslbtlilylalhebsswdamage,InclWNgbssoluse,lslJmiledlo _ilCuslome~accepls <br />L~W al lhe lime d <br />l b <br />l <br />l <br />ill <br />f <br />h @ ppY <br />ren <br />a <br />y <br />n <br />a <br />ng I <br />e axept box bebw antl pays Ne addilqral lce spec lietl In Ne com~wlalion cdumn <br /> <br />er Guslomer shall pay IM lull cost ol bss w damage, InWdieg bss ol use lo Vehkle if deGir~es box bebw k inillaktl. i <br />PHYSICAL DAMAGE TO VEHICLE (NOtE: ONy one d IM lonv.ving MuST be ini~iaktl) ~ <br /> <br />Cuslomerace¢pISLOW. Cvslomn(Ieci~nosLOwanAaqees PEfI HaUfl <br />RFFf11Q.CHN7OE Np, Ilng <br />I1L'FFlIG.~D~fiCjE i <br />lo pay IM1e IuA cosl ol bss a tlartage <br />~ <br />LOWIS <br />UFANCE <br />1 IolheVehk N soluse. OP[H 71LE ~~ <br />U1~I~UJ~57~. oc .^+~enn CP~°FlMILL <br />•oaoeno <br />li'rHncuusr. ~ <br /> ~ .~ ,,,,oa„ <br /> X INITIAL i SUD•T07AL FD ~ SUB-TOTAI ~ ~/ ~ <br />CUSTOMEfl IS RESPONSIBLE FOR ALL OVE HEAd"6 MAGE 'S T~ % TAX ; <br />ACCEPiS p[q5q~p1p~0ENI~ E~vnp DUWE LDW~ ADDIi PEFl ~ <br /> /~ DA OAY <br />~ <br />X , <br />.oYWtlN~S.a.~ara.e~nesaxcceM+oun• h~/cee~sca.nageai~~c~amarm.naaaw <br />~ i • <br />~MlIAL <br />. ~acFnpKVgpspty.prpatlpreSYNOPySd <br />IsM1ttlbyL¢ssnal~mlaL <br />"'1 <br />~ ~ <br />~~mik <br />FlEFUCLSERVICC ~~ <br />eaenao kO.GND.."'_ <br /> <br />oo <br />.eoaoon REFULLSCH~i::i. ~ <br />unBlurvcnoi[6iqH N T~9nlyon I eldbwi~gmu 1 INtialed.) <br />~iaWlityProleclbnlnparagaph 0~ Lia -ilylnsura ' byCuslonier r~l ~ i <br />onreversesldeproNdetlbyLe -as rpa~a verse9tle. ITIAL ~ pAYS <br />OAY <br />~• ~~- ~ SUBTOTAL ~ ~ ~ <br />DISPATCHED ~ LESS OIL <br />T <br />~ <br />^YniHOAhNGE ^WITMqff0AA1AGE ~MTN <br />iALS ANDflEPNRS <br />LS NIi <br />CUSTOMEHSHOULOPEADiHEAU01T10N~lTERMSANOfANDIT10N50NTNENEVER5ESI0EOFTHISAGHEEMEM REBILL i <br />WMNING: MinlmumCharge:OneDayPlusMdea <br />eChar <br />es <br />g <br />q <br />'Vehkleshalliwlbaoperdletlbyanyperson¢xceptGuslomerdrqlheldlowingAulhorizetl00¢~d1IX5wlromusll~e2lormoreyeai501dgc,dWyWalilledandval"Mty SUBTOTAL - i , <br />Ilcensed Iooperale VehlGC.antlhaveCuslomer's priorpermisSbn.AullwrixetlOperalwsare;IheemObyer, parlner <br />execulrveoKcer <br />orregularempbyee(s7olQislomer <br />w <br />, <br />. <br />, <br />addilional aNhorized operala(sl approved by L¢ssor in vnill~g. Cuslomer will rrol surrentler Ihe uu d Vehkle lo an~wie olher Ihan Ihe peWOUSI <br />tlescribed ~ESS SIT REC'D <br />y <br />operala(54 <br /> <br />' CretlilC <br />rdC <br />l <br />lh <br />i <br />L DA i <br />a <br />~s <br />omera~ <br />p <br />zes <br />essortopocessavetlilcaitlvoucher~ilappfrzMe~lnCUSlwnersramelorallcharges. IICUSIOmereleclSloreNrnVehclewilhless <br />Iuellhanwhenrenletl,GuslomershallpayLessa'srelo~ngservkecharge.Deposilw~ImlbereluntletllnlullunlilallamounlsdueuntlerlhtsAqreemenllrclud~gOhysical T TAL ~ ~ <br />tlamage are oaltl alb all eqviprn»t ~enletl by Lessor relurned al Ih¢ Iime VehkAe Is checketl in. NI rlwges are sob}ecl lo Gnal autlil by lessor. <br />' LESSON MpNES NO WAqqqNTIES, E%PPESS, IMPLIED ON STATUTOPY, INClU01NG, BUT NOT LIMITED TO iHE IMPLIED WARPANTIES OF ~~~ <br />MEqCNl~[lTABILITY AND FITNE53 FOH A PANTICULM PURPOSE. CUSTOMEfl PEPRESENTS THAT HE/SHE HAS FULIY INSPECTED THE VEHICLE <br />OESCHI6EOHEflEINANDTHATSAMEI51NGO00CONDITIONANDpEPAIq. i <br />' Cuslomer Is f~abk Iw a0 damages lo Vehlcleas a rewllo/InsuHKlenl Geararcz (helghl w witllh) antl lor all parking antl Iralik vidalrons <br />aiW mosl lmmetlialel <br />reporl a1 ~~H <br />, <br />y <br />accldenls antl complele Lessor's accitlenl repoel lam. <br /> <br />' The Vehkle described hwein k renletl W~saanl lo and In accortla~e vriN Ihe le~ms antl contlilbns sel wl above aiW m rwnse sitle ol lhls Agrremenl. Cuslomer CHAflGE CARD <br /> <br />I <br />mnresenls Ihal he/sM has reatl aiM a9~ees lo same. and has receivetl Vehkle Inspeclim qepal and D~iver Li0 Reppls xTCre aiM xfien reqobetl antl will Ommply <br />compleleandrelumlhemloLessorSeeievxrsesitle . ^ rUnGihS[ Oaoen <br />._ ~'J/ ~/ ~ <br />/ <br />1 <br />