Membership Application

Apply to join the membership-based vehicle access program. Approval is required before any vehicle can be assigned.

Full Name

Date of Birth

Phone

Address

Driver License #

DL State

DL Expiration

Insurance Required (Member-Provided)

Private Car Rentals LLC does not provide insurance. You must maintain valid insurance coverage (personal, employer, platform, and/or third-party coverage).

Do you have your own insurance?

Insurance Provider

Policy Number

Policy Expiration

Click-to-Accept

By applying, you acknowledge this is a membership-based vehicle access program (not a traditional car rental). Membership does not guarantee vehicle availability, does not include insurance, and vehicle use is governed by separate Vehicle Assignment & Weekly Usage Agreements.

I agree to the Membership Agreement, Insurance Disclosure, and Program Rules.

Insurance acknowledgment. I understand that Private Car Rentals provides only state-minimum liability coverage if and to the extent required by law, and does not provide collision, comprehensive, medical payments, PIP, UM/UIM, roadside assistance, loss-of-use, rental reimbursement, or other coverages unless separately agreed in writing. I am responsible for maintaining my own insurance and any required endorsements for my intended use (including rideshare/delivery/employment where applicable).

See: Insurance Disclosure • Vehicle Assignment • Membership Terms

You will receive a Membership ID after submission.