Midwest Motorcycle Daytona - Rental Contract

Midwest Motorcycle

Rental Contract

MINIMUM REQUIREMENTS: CUSTOMER AGREES TO PROVIDE DEALER WITH PROOF OF SOME OR ALL OF THE FOLLOWING: (a) Customer is 21 years of age; and (b) Customer possesses a valid picture driver's license containing a motorcycle endorsement from his/her home state or country; and (c) Customer possesses a major credit card; and (d) if Customer resides outside of the United States, proof of a current passport.

Customer Information

Driver Name

First Name

Middle Name (optional)

Last Name

Address

City

State

Zip

Cell #

Work #

Employer

Email*

Date of Birth

Driver's License No.*

State Issued

Motorcycle Endorsement

Yes No

Passenger Name

First Name

Middle Name (optional)

Last Name

Rental Dates Requesting

From

Rental Unit Desired*

Customer's Driving Record

How long have you had a driver's license?

How long have you had a motorcycle endorsement?

In the last 3 years, have you ever been convicted of an alcohol driving offense, a driver's license offense, suspension, cancellation or revocation, careless driving, reckless driving, vehicular endangerment or homicide, or has your license been suspended or revoked for any reason?

Yes No

When and for what reason?

I hereby authorize and state that I have a valid driver's license and a motorcycle endorsement and my driving privileges are not suspended or revoked and I authorize verification of my driver's license and driving privileges by signing below.

Date

All deposits are refundable up to 2 weeks prior to the date of pick up.

Signature

[clear]

Use your mouse or finger to draw your signature above

Motorcycle Use History

Do you own a motorcycle?

Yes No

What kind?

How many years have you been riding a motorcycle?

What type of motorcycle have you ridden?

How often do you ride?

Last time ridden?

Have you attended an approved class of instruction for motorcycle operation?

Yes No

Only unleaded PREMIUM 93 OCTANE or higher gas shall be used for the motorcycle.