ML Disclaimer 2016 with Liability

We are pleased to offer you a monthly rental program so that you may enjoy the freedom of selecting a new vehicle of your choice without costly maintenance or depreciation. Our program is very unique, and many carriers will not provide complete coverage. We want to be sure ALL our customers are aware of any possible liability exposure. We certainly hope no unpleasant events occur during your rental, but it is something to discuss BEFORE a loss occurs. As with your own personal vehicle, you are responsible for any damage that would occur to our vehicle or others, while the vehicle is in your possession, regardless of fault. We want to reiterate all the loss elements with you, our valued customers. Please review the Loss Elements below with your insurance carrier to determine if your coverage will translate to this program.

Loss Elements: Please be sure to review each item listed below with your carrier and confirm your coverage and policy information.

  1. 1)  Physical Damage: You are responsible for any loss or damage to the vehicle regardless of fault. This includes any unpaid portion of the deductible.
  2. 2)  Towing & Storage Fees: In the event the vehicle would require towing you would be responsible for any towing or storage fees that may be charged.
  3. 3)  Loss of Use: You are responsible for any loss of use we experience as a result of the car being unavailable for business use. You will be charged at the rental rate, without regard to fleet utilization, in accordance with the legal definition and formula.
  4. 4)  Diminished Value: You are responsible for any manufacture penalty at the time of turn back OR any difference between the retail fair market value and the sale amount after the loss as a result of the nature of the damage (whether or not we repair the vehicle).
  5. 5)  Administrative/Appraisal Fee: You are responsible for any and all admin fees required to handle & settle your claim.
  6. 6)  Make and Model of Vehicle you are renting (some policies may exclude coverage for luxury vehicles or SUV/trucks)
  7. 7)  Discuss and verify how long you wish to participate with the program (some policies may only cover a limited time period).
  8. 8)  Is this vehicle to be used for business or personal use? Your carrier may not cover business use, under a personal policy.
  9. 9)  Do you need to add the vehicle to your policy and/or add us as an additional insured? If so, we will require a copy of the policy.
  10. 10)  Liability coverage-You need to have a liability policy/coverage that will cover damages to any other party or property.

In order to proceed with the program, please discuss, and obtain verification of coverage for items 1-10 above from your provider to make sure you are 100% covered and verify below. We have had customers email the form to their providers for review and verification in writing, providing us with a copy for our files. Please obtain verification for items 1-10 in writing from your carrier!

Additional Coverage Questions: As always, we are here to serve you! Please let us know if you have any questions or concerns. Our Damage Claims Manager & Customer Advocate, Katherine English, can be reached at 717-226-1842 or via email at kenglish@budgetharrisburg.com

Insurance Carrier that Verified Damage Coverage : __________________________ Policy #________________________Date:__________ Insurance Representative (First & Last Name) Name :________________________________Phone #______________________ Insurance Carrier that Verified Liability Coverage : ___________________________ Policy #________________________Date:__________ Insurance Representative (First & Last Name) Name :________________________________Phone #______________________

Now that you have verified the extent of your coverage, we are happy to offer the following options to make sure you are covered!
Optional Waivers: To help our customers address any gaps in their insurance coverage, we have begun offering the following waivers with our mini-lease program. Please choose from the options below by initialing next to your selection and sign below. Thank you & Enjoy the program!

______ – $49/month – “Extras” Waiver covers loss of use, diminished value, admin & appraisal costs, glass and tire repair (includes damage to rubber only, no coverage on the wheels or rest of vehicle)

______ – $89/month – “Extras Plus Deductible” Waiver – includes all items in the “Extras” waiver plus covers the first $500 of any physical damage to the vehicle from an accident or normal driving activity. Damage over $500 is customer’s responsibility.

______ – $119/month – “Complete Loss Damage Waiver” Complete loss damage waiver, covers any and all damage to our vehicle with payment of a $1000 deductible – maximum customer responsibility. *Note-This does coverage does not include any liability coverage.

______- $14.99/day-Supplemental Liability Coverage. If you deny our Liability coverage, you must confirm your own existing liability coverage.

______ – $0/month – No waivers, you are 100% responsible for any charges your insurance company does not cover. If you deny all of our optional waivers, you must confirm you have damage and liability coverage that will apply. Please obtain a confirmation of coverage from your carrier for the items listed above in writing, to ensure you are protected!

NOTE: Any coverage purchased is VOID if any of the contract terms are violated. Please see rental jacket and contract for info.

Customer Name:__________________________ Customer Signature:______________________________ Date:__________