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					Join Avis Preferred Service
Enrollment Profile—Master Rental Agreement
U.S. and Canadian residents (including Puerto Rico & U.S. Virgin Islands)
Yes! Enroll me in Avis Preferred Service at no extra cost—for added speed and convenience.*
Full Name: Company Name: Address: City: Daytime Phone #: Driver’s License #: Wizard #:
(If applicable)

Home

Business

State:

ZIP Code:

-

-

Evening Phone #:

Q023592
(If applicable)

-

E-mail: Date of Birth:

State of Issue: AWD #:

/

/

Driver's license is subject to verification from the state of issuance. Avis maintains certain criteria that may cause a denial of a rental opportunity.

I prefer the following car group and corresponding make/model:*
Compact (B) Chevrolet Cavalier Pontiac Sunfire Intermediate (C) Oldsmobile Alero Pontiac Grand Am Full-size 2-Door (D) Pontiac Grand Prix Chevrolet Monte Carlo Full-size 4-Door (E) Chevrolet Impala Chevrolet Malibu Premium (G) Buick LeSabre Pontiac Bonneville
*based on availability

Luxury (H) Cadillac Sedan DeVille

I prefer a non-smoking car*

The credit card I prefer to use for payment is:
American Express® Credit Card #: Diners Club® Discover® /Novus® Exp. Date: Diners Club® MasterCard® Visa® Sears®

/
MasterCard® Visa® Sears®

Alternative credit card:
American Express® Credit Card #: Discover® /Novus® Exp. Date:

/

Avis accepts many major credit cards as credit identification at the time of rental. An Avis honored credit card must be provided to enroll in and use Avis Preferred Service. Debit cards may only be used for payment of charges at the conclusion of the rental.

Optional Service(s)
YOU MUST ACCEPT OR DECLINE EACH of these options by initialing below. See enclosed Terms & Conditions for full descriptions. Accept LDW Loss Damage Waiver PAI Personal Accident Insurance PEP Personal Effects Protection ALI Additional Liability Insurance Decline

To request Avis Preferred service in Europe, Australia and New Zealand, please fill out the entire form and check the box below.
Yes, I want the information on this completed enrollment profile to act as my enrollment for rentals in Europe, Australia and New Zealand and request that the Terms and Conditions for Preferred Service in those areas be sent to me with my membership card. I hereby agree that my initial Preferred rental transaction in Europe, Australia or New Zealand shall constitute acceptance of all those Terms and Conditions applicable to the country of rental.

I have read, understood and agreed to the enclosed Preferred Service Rental Transaction Terms and Conditions and the LDW disclosure/state warning notices referred to below.

X
Signature (Mandatory)

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Date

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*Be sure to complete each item. Submitting an incomplete form may delay your enrollment. Mail back this postage-paid form, FAX this form toll-free to 1-877-769-5787 or visit avis.com. If you want to modify a particular rental in any way, stop at the Avis counter first. I have read and agreed to the Avis Preferred Service Rental Transaction Terms and Conditions enclosed, as well as on this profile. I acknowledge that I have read and understand the TX, HI, IN, CT, CA, NV, VA, MD, KS, CO and LA Disclosure Notices and MN Consumer Protection Notice concerning the Loss Damage Waiver (LDW) option. I also acknowledge receipt of warning notices for rentals in DC, AZ and WA. I am waiving my right to receive and sign the notices at the time of rental to avoid delay of my Preferred Service rental transaction. I understand that all information on the form is subject to verification by Avis. Notice for Dade County, Florida: You must be provided with a road map with each rental. Your signature on this document acknowledges receipt of that map; therefore, you need not sign for it at time of rental. Note: Processing for Preferred membership will take approximately 2–4 weeks. You will receive your Avis Preferred card in the mail. Therefore, Preferred status may not be available for your next rental.

Please print, sign and fax this form to 1-877-769-5787 to enroll in Avis Preferred Service.


				
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