Dollar Cash Deposit
Identification Card
Application
TO APPLY FOR YOUR CARD:
• Complete both parts of this application
• Be sure to sign at the bottom
• Return with $15.00 non-refundable processing fee* to:
Dollar c/o Hertz
Post Office Box 25991
Oklahoma City, OK 73125
(*Send Check or Money Order)
PART ONE Please Print Clearly
Last Name
First Name
Middle Initial
Optional:
Employer or Firm Name (Limit to 25 Letters Including Spaces)
Mrs. Ms. Miss Mr. Dr.
Residence Address (Limit to 25 Letters Including Spaces)
Business Address (Limit to 25 Letters Including Spaces)
Mail Card & Bill To:
(Please Check One)
City and State (Limit to 25 Letters Including Spaces)
Zip Code
Driver’s License Number
State
Car Preference
I Usually Rent
Luxury
Premium
Full Size 4-Door
Special Sporty
Mid-Size
Compact 4-Door
Residence
Address
Business
Address
City and State (Limit to 25 Letters Including Spaces)
Expiration Date
Compact 2-Door
If you have a major credit card, please indicate which one at right (e.g. Visa, Mastercard, Carte
Blanche, Diners Club, American Express, Discover/Novus, JCB).
Zip Code
Company CDP Number (if any)
This Card is For
Name of Credit Card
Personal Use
Business Use
Both
Credit Card Account Number
PART TWO
Your Position
Type of Business
Residence Telephone Number
Years at This Address
Own Home
Rent
Previous Employer
Years With This Company
Previous Employer’s Address, No., Street, City & State
Business Tel. Number
Years With This Company
Annual Income
Date of Birth
Social Security Number
Personal Checking Account (Bank Name) Branch Address
Previous Residence Address (If Present is Less Than 5 Years)
Account Number
Spec.
Reg.
Name/Address of Closest Relative Not Living With You
Other Major Credit Cards: Company & Number
1.
Number
Please issue a Cash Deposit Identification Card (“Card”) to me in the name set forth above. I
understand that a Card will not be issued to me unless I am at least 21 years of age. Exceptions
to this age restriction apply for use on rentals in the states of Michigan and New York, wherein
an application for the Card may be made if I am at least 18 years of age. DTG Operations, Inc.
d/b/a Dollar Rent A Car (“Dollar”) and its parent corporation, The Hertz Corporation (“Hertz”)
are authorized to verify any information it requires for this application including but not limited
to the use of information obtained through various credit reporting agencies, subject to the Fair
Credit Reporting Act. I understand I will be required to leave a deposit in cash, in accordance
with Dollar’s then current rules, at the time and place of each rental as a condition precedent to
such rental and will pay all charges incurred for such rental in excess of such deposit, in cash,
immediately upon completion of such rental. A CARD IS NOT A CREDIT CARD, NOR WILL IT
ENTITLE ME AS A CARDHOLDER TO CREDIT PRIVILEGES.
The Card will be issued only on approval of this application by Dollar, and Dollar, in its sole
discretion, retains the right to accept or reject this application. If the application is rejected,
the $15.00 processing fee WILL NOT BE REFUNDED. If a Card is issued to me, it will be
accompanied by a cardholder agreement.
Applicant’s Signature
2.
Number
My retention and/or use of the Card will constitute my agreement to be bound by all of the
terms and conditions set forth herein.
The Card is the property of Dollar and is non-transferable. The Card may be cancelled,
invalidated, and/or the conditions of its use modified without notice to me. I will surrender it to
Dollar upon request. Dollar reserves the right to repossess a Card with or without demand, and
I hereby waive prior notice, a pre-seizure hearing and judicial process as a prior condition to
Dollar’s repossession of the Card.
Cash Deposit Identification Card may be used at Hertz, Dollar Rent A Car, Thrifty Car Rental
and Firefly Rent A Car.
I understand that only I will be authorized to use the Card. I will be liable for all charges
incurred by authorized use of the Card. I will also be liable for unauthorized use occurring
prior to notifying Dollar c/o Hertz at P.O. Box 25991, Oklahoma City, OK 73125 or by telephone
at 800-654-4173 of loss, theft or possible unauthorized use. Written notice will not be
effective until received by Dollar/Hertz.
Date