Full Name:

Cell Phone:

Home Phone:

Email:

Billing Address:

Billing City:

Billing State: Select... AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Leave blank for outside US

Billing Zip:

Country:

Driverse License #:   State Issued:

Rental Machine(s):

RZR XP1000 2-seat $600~customer-field-33~ How many?~customer-field-44~

Maverick X3 Turbo 2-seat $750~customer-field-34~

RZR XP1000 4-seat $650~customer-field-35~

RZR XPTurbo 4-seat $750~customer-field-36~

Starting Date: 

Ending Date: 

Credit Card #:

CC Experation Month/Year: Select...010203040506070809101112/ Select...20242025202620272028202920302031

CC Cvv Code:

The above credit card will be used for the rental and security deposit. The $3500 security deposit per vehicle will be ran as an authorizational hold on the day of the rental and will show pending on your card for 1 week as long as no damage is present upon return of the rented vehicle. No refunds will be given unless by owners discretion.

Shortly after submitting this form a rental agreement will be sent to the email listed above to e-sign. If you do not see the email make sure you check your spam/junk mail.

By signing this form I agree to be charged for the above selected date, time, and machine(s) to be rented.

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