PRE-REGISTRATION

Please fill out this form and submit to Americar Auto Rental. This will speed up the reservation process. Someone will you within 24 hours to complete your reservation.

Your Full Name
Street Address		City
State	Zip	Home Phone
Employer		Work Phone
Local if Different from Above
Local Address		Local Phone
Insurance Company		Policy No.
Requested Date of Delivery		Pick up Time
Number of Days
If this is an insurance claim, please complete the following:
Name of Agent		Phone No.
Adjuster		Claim No.
Date of Loss		Type of Loss:	Stolen Accident
Year and Make of Your Car		Model
Name of Body Shop

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