THIS IS A SUMMARY ONLY AND IS SUBJECT TO ALL OF THE PROVISIONS,
LIMITATIONS AND EXCEPTIONS OF THE APPLICABLE LIABILITY
INSURANCE SUPPLEMENT, PERSONAL ACCIDENT AND PERSONAL
EFFECTS INSURANCE POLICIES AND THE AGREEMENT GOVERNING
THE RENTAL. (SEE PARAGRAPH 3 OF THE ENROLLMENT AGREEMENT
WHICH ACCOMPANIES THIS SUMMARY FOR AN EXPLANATION OF THE
DOCUMENTS WHICH COMPRISE THIS AGREEMENT; GENERALLY, TERMS
WHICH ARE DEFINED IN THE ENROLLMENT AGREEMENT SHALL HAVE
THE SAME MEANINGS FOR PURPOSES OF THIS SUMMARY.) A MORE
DETAILED SUMMARY APPEARS IN THE NORTH AMERICAN TERMS.
COPIES OF THE INSURANCE POLICIES ARE AVAILABLE FOR INSPECTION
UPON REQUEST; SINCE RENTALS FROM DIFFERENT LOCATIONS ARE
COVERED BY DIFFERENT POLICIES, YOU SHOULD STATE THE LOCATION
FROM WHICH THE CAR WILL BE RENTED WHEN REQUESTING A COPY
OF A POLICY.
FOR INFORMATION REGARDING THE OPTIONAL LOSS DAMAGE WAIVER
(“LDW”), WHICH IS NOT INSURANCE, SEE PARAGRAPH 4 OF THE
ATTACHED ENROLLMENT AGREEMENT. ADDITIONAL INFORMATION
REGARDING LDW MAY BE FOUND IN THE NORTH AMERICAN TERMS.
THIS SUMMARY IS AS OF JANUARY 1, 2006. OPTIONAL SERVICES
OFFERED, COVERAGES, LIMITS, EXCLUSIONS, OTHER FEATURES AND
PRICES ARE ALL SUBJECT TO CHANGE WITHOUT NOTICE.
1. LIABILITY INSURANCE SUPPLEMENT (LIS): SUMMARY OF
COVERAGE
(Available on rentals in the United States only)
COVERAGE
If You elect to purchase LIS, coverage will be provided to You and any Authorized
Operators under an excess automobile liability insurance policy issued to The
Hertz Corporation or the independent Hertz licensee from which You rent the Car.
LIMITS
LIS provides protection from third-party automobile liability claims for
the difference between the liability protection limits provided under the
North American Terms and a maximum combined single limit of One
Million (US$1,000,000) Dollars for bodily injury, including death, and
property damage. For rentals where The Hertz Corporation is the Renting
Company, LIS also provides uninsured and underinsured motorists coverage
for bodily injury and property damage, if applicable, for the difference
between the statutory minimum underlying limits and US$100,000 limit
of insurance for each accident; however, this coverage is not currently
provided when the Renting Company is a Hertz licensee for rentals in
those states where such coverage is not mandatory. For rentals commencing
in New York or Vermont, where The Hertz Corporation is the Renting
Company, LIS provides uninsured and underinsured motorists coverage
for bodily injury and property damage, if applicable, for the difference
between the statutory minimum underlying limits and US$100,000 per
person/US$300,000 per accident for rentals commencing in New York or
US$50,000 per person/$100,000 per accident for rentals commencing in
Vermont; recoveries under any per accident limit are subject to the per
person limit.
EXCLUSIONS
All exclusions, including claims arising from use of the Car as prohibited by the
agreement governing the rental and claims by any of Your or any Authorized
Operator’s family members related by blood, marriage or adoption who resides
with You or the Authorized Operator, are set forth in the applicable policy, a
copy of which is available upon request.
HOW TO OBTAIN/DECLINE COVERAGE
If You indicate that You Accept” LIS in Your Enrollment, coverage will be
provided during the rental period for each Hertz #1 Club Gold rental which
You make in the United States (including Puerto Rico and St. Thomas). As of
January 1, 2006, the daily Charge for this optional coverage was US$12.95
or less per day, but the Charge is subject to change without notice. THE
CHARGE AT THE TIME YOU RENT WILL APPEAR ON THE RENTAL
RECORD. Such daily Charge is due for each full or partial rental day.
Your Rental Record may contain additional disclosures pertinent to Your
decision whether to accept or decline LIS in the jurisdiction in which the rental
commences. YOU SHOULD READ THESE DISCLOSURES CAREFULLY AT
THE COMMENCEMENT OF THE RENTAL. If You have declined LIS in Your
Enrollment, You may nevertheless accept LIS for a specific rental by advising
a Hertz representative of Your decision at the commencement of the rental
and having the representative revise the Rental Record to reflect Your election.
Likewise, if You have accepted LIS in Your Enrollment, You may elect to decline
LIS for a specific rental by obtaining a revised Rental Record from a Hertz
representative at the commencement of the rental.
At certain locations, Hertz may offer LIS coverage with higher limits. THIS
EXTENDED LIMIT OF LIS COVERAGE, WHEN AVAILABLE, MAY ONLY BE
SELECTED AT TIME OF RENTAL AT A HIGHER DAILY CHARGE.
2. PERSONAL ACCIDENT INSURANCE (PAI) AND PERSONAL
EFFECTS COVERAGE (PEC): SUMMARY OF COVERAGES
(Available on rentals in the United States and Canada)
HOW TO OBTAIN PAI/PEC COVERAGE
If You indicate You “AcceptPAI/PEC in Your Enrollment, coverage will be
provided during the rental period of each Program rental in the U.S. and
Canada. Please note that PAI and PEC are not available separately and may
only be taken in combination. As of January 1, 2006, the Daily Charge for
optional PAI/PEC coverage is US$5.50 or less in the U.S. and CAN$7.95
in Canada, but the Charge is subject to change without notice. The Charge
at the time You rent will appear on the Rental Record. Such Charge is due
in full for each full or partial rental day. Coverage will be provided under a
policy issued to the Renting Company (as identified on the Rental Record).
As of January 1, 2006, for rentals commencing at facilities operated by The
Hertz Corporation in the United States, the policy under which PAI/PEC
coverage will be provided is issued to The Hertz Corporation by National
Union Fire Insurance Company of Pittsburgh, Pennsylvania.
PERSONAL ACCIDENT INSURANCE (PAI):
COVERAGE AND BENEFITS
For rentals in the United States, the PAI policies provide coverage for death
directly caused by an accident independent of all other causes. The renter
will be covered for any such accident during the rental period; passengers
will also be covered, but only for accidents occurring while in, entering, or
exiting the Car. Benefits in most parts of the U.S. include death benefits of
US$175,000 for the renter and US$17,500 per passenger; PAI also provides
limited coverage for medical and ambulance expense. In most parts of the
U.S., benefits for any one accident are limited to US$225,000. For rentals
in Canada, the PAI policy provides coverage for accidental death and/or
dismemberment caused by an accident. The death benefit is CAN$100,000
for the renter and CAN$10,000 per passenger; dismemberment benefits are
paid in accordance with a schedule of benefits specified in the policy. The
renter will be covered for any such accident during the rental period; limited
benefits are also payable to passengers who may be injured in an accident
but only while they are occupants of the Car. These benefits are payable
without regard to any other benefits which may be due under any other
insurance policy. Coverage in both the U.S. and Canada is subject to various
exclusions, terms and conditions.
EXCLUSIONS
In most parts of the United States, PAI insurance excludes coverage for injury
or death resulting from use of the Car in violation of the agreement governing
the rental and also for injury or death which: (a) is intentionally self-inflicted;
(b) results from aircraft travel; (c) results from committing or attempting to
commit an assault or felony; (d) results from intoxicants or narcotics unless
administered on the advice of a physician (in Canada, this exclusion applies
regardless of being administered on the advice of a physician); or (e)
results from suicide or attempted suicide while sane or insane. DIFFERENT
EXCLUSIONS MAY APPLY FOR RENTALS IN CANADA AND FROM
INDEPENDENT LICENSEE LOCATIONS IN THE UNITED STATES.
PERSONAL EFFECTS COVERAGE (PEC):
COVERAGE
For rentals commencing in the United States, coverage is provided for loss of
or damage to covered personal effects owned by any covered persons while
such personal effects are in transit or in any hotel or other building en route
during a trip using the Car. For rentals commencing in Canada, coverage is
provided only while such effects are in the Car.
COVERED PERSONS
For rentals commencing in the United States, You and members of
Your immediate family traveling with You during a trip using the Car who
permanently reside in the same household with You are covered, if You accept
PAI/PEC. For rentals commencing in Canada, You and any persons traveling
with You are covered up to a maximum of three people in total.
LIMITS OF LIABILITY
Maximum coverage during each rental period is US$600 in most parts of
the U.S. for each covered person. In Canada, the maximum coverage during
each rental period is CAN$500 per covered person up to a maximum of three
persons, after a deductible of CAN$25 per covered claim. Total benefits in any
rental period are limited to US$1,800 in most parts of the U.S. and CAN$1,500
in Canada. In New York State, the maximum coverage is US$500 for each
covered person, per occurrence, and the total benefits in any rental period is
limited to US$1,500.
EXCLUSIONS
The following personal effects are not covered for rentals from rental
facilities operated by The Hertz Corporation in the U.S.: Animals,
automobiles, automobile equipment, motorcycles, boats, motors or other
conveyances, household furniture, contact lenses, artificial teeth and limbs,
currency, coins, deeds, bullion, stamps, securities, tickets, documents and
perishables. (THESE EXCLUSIONS MAY VARY FOR RENTALS IN CANADA
AND FOR RENTALS FROM INDEPENDENT LICENSEE LOCATIONS IN
THE UNITED STATES.) Any loss of or damage to personal effects caused
by mysterious disappearance or use of the Car in violation of the Agreement
is not covered. Benefits are not payable for delay, loss of market, indirect or
consequential losses or damages of any kind.
SUMMARY OF OPTIONAL SERVICES AVAILABLE FOR RENTALS IN THE UNITED STATES AND CANADA
4864 SOS06/0807
9. NOTICE: IF YOU HAVE COLLISION COVERAGE UNDER
YOUR OWN AUTOMOBILE INSURANCE POLICY
WRITTEN IN LOUISIANA, YOUR COLLISION COVERAGE
AUTOMATICALLY EXTENDS TO RENTAL MOTOR
VEHICLES PURSUANT TO R.S. 22:1406(F). EVEN IF YOU
ARE NOT A LOUISIANA INSURED DRIVER, THE
PURCHASE OF LOSS DAMAGE WAIVER IS NOT
MANDATORY AND MAY BE WAIVED. THIS CONTRACT
OFFERS, FOR AN ADDITIONAL CHARGE, A LOSS
DAMAGE WAIVER TO COVER YOUR RESPONSIBILITY
FOR DAMAGE TO THE VEHICLE. BEFORE DECIDING
WHETHER TO PURCHASE THE LOSS DAMAGE
WAIVER, YOU MAY WISH TO DETERMINE WHETHER
YOUR OWN AUTOMOBILE INSURANCE AFFORDS YOU
COVERAGE FOR DAMAGE TO THE RENTAL VEHICLE
AND THE AMOUNT OF THE DEDUCTIBLE UNDER
SUCH COVERAGE.
10. Under Minnesota law, a personal automobile insurance
policy issued in Minnesota must cover the rental of
the motor vehicle against damage to the vehicle and
against loss of use of the vehicle. Therefore, purchase
of any collision damage waiver or similar insurance
affected in this Enrollment Agreement is not necessary
if Your policy was issued in Minnesota.
11. FOR RENTALS COMMENCING IN TEXAS, YOU MAY
NOT NEED THE AUTOMOBILE LIABILITY INSURANCE
OFFERED BY HERTZ. YOUR TEXAS AUTOMOBILE
POLICY PROVIDES COVERAGE FOR YOUR LIABILITY
WHILE OPERATING A RENTAL VEHICLE. AUTOMOBILE
POLICIES ISSUED IN OTHER STATES OR COUNTRIES
MAY ALSO DUPLICATE THIS COVERAGE. THE
PURCHASE OF AUTOMOBILE RENTAL LIABILITY
INSURANCE IS NOT REQUIRED AS A CONDITION OF
RENTING AN AUTOMOBILE. THIS INSURANCE DOES
NOT APPLY TO ANY BODILY INJURY OR PROPERTY
DAMAGE ARISING OUT OF THE USE OR PERMITTING
THE USE OF A RENTAL VEHICLE BY ANY DRIVER
WHILE UNDER THE INFLUENCE OF DRUGS OR
ALCOHOL IN VIOLATION OF THE LAW.
12. The availability of Gold service at specific locations may change.
Reservations made not less than two (2) hours in advance of
proposed rental commencement are required for Gold rentals.
13. You represent that the information which You have provided on
this Enrollment Agreement is true, correct and complete. Your
selections in Your Enrollment of Optional Services (where available)
and car class (subject to vehicle availability at the time You make
the reservation) will apply to all rentals which You make in the
United States and Canada using Gold; provided, that You may
change Your selections of Optional Services for a specific rental by
obtaining a revised Rental Record from a Hertz representative at the
commencement of the rental and You may select a different car class
for a specific rental at the time You make the reservation.
14. You authorize Hertz to process all charges in any way incurred by
You in connection with a Gold rental against the first credit, charge
or debit card listed on this Enrollment Agreement (as such list may
be modified from time to time in the manner described in section 2,
above) which has available credit or funds, as the case may be, and
which is accepted to qualify for rental at the rental location.
15. You promise to notify the Enrolling Company at once if Your Hertz
#1 Club Gold card, Hertz credit card, #1 Club number or any of the
credit, charge or debit cards listed in Your Enrollment are lost, stolen
or invalidated or if You suspect that any of them are being used
without Your permission. Because of the nature of Hertz #1 Club
Gold, You understand the urgency of this obligation.
16. As of September 4, 2007, the Gold membership fee is US$60 for
one year, which fee may be waived by Hertz. At any time during
the year You may notify the Enrolling Company in writing of Your
desire to cancel Your Gold membership and obtain a refund of
Your paid membership fee for the remaining months of the year.
Hertz reserves the right to cancel or suspend Your membership
for any reason at any time, without notice. If Hertz cancels
Your membership, it will refund to You a pro-rata portion of the
membership fee You paid with respect to the period in which the
cancellation occurs, unless cancellation occurs following Your
failure to pay any sums payable by You to Hertz or any of our
licensees, subsidiaries or other affiliates or Your violation of any of
the terms of this Agreement or any other obligation owed by You to
any Hertz company. If You return Your Gold card within thirty (30)
days of receipt, and before renting a car using Gold, then You will
receive a full refund of Your membership fee. Your membership will
expire on the expiration date specified on Your Gold card, or in the
absence of such expiration date after 12 months from submission
to You of such card, unless, in either case, Your membership is
renewed or extended for an additional period of 12 months upon
payment by You of any membership renewal fee notified to You by
Hertz. Hertz reserves the right not to renew Your membership and
will not be obliged to provide any explanation for not doing so.
By signing the Hertz #1 Club Gold Enrollment Agreement for rentals in
the U.S. and Canada (this “Enrollment Agreement”), You acknowledge
and agree that:
1. You have received, read, understand and agree to the terms, conditions,
disclosures and notices in this Enrollment Agreement, including these
North American Enrollment Agreement Terms. This Enrollment Agreement
pertains to Hertz #1 Club Gold (“Gold”) rentals in the United States and
Canada. A booklet (the “North American Gold Rental Booklet”) setting
forth terms and conditions applicable to Gold rentals in the United
States and Canada and other matters will be sent to You with Your
Gold membership card following acceptance by us of this Enrollment
Agreement. You promise to read the booklet carefully. Your making a
rental in the United States or Canada using Gold will constitute Your
acceptance of all terms and conditions specified in the North American
Gold Rental Booklet, including the General Provisions Applicable To All
Hertz #1 Club Gold Rentals (the “General Provisions”), the Terms And
Conditions Applicable To Rentals In The United States And Canada
(the “North American Terms”) and the Company/Travel Agent Accounts
Supplementary Terms and Conditions. If, after reading the North American
Gold Rental Booklet, You wish to change any of the selections made by
You in this Enrollment Agreement, You may do so in the manner described
in section 2, below.
2. The submission of this Enrollment Agreement represents an offer by
You. The Hertz company the name of which appears on the reverse
side of this form (the “Enrolling Company”) reserves the right not to
accept this Enrollment Agreement without being required to provide any
explanation. Acceptance of this Enrollment Agreement by the Enrolling
Company will be given by written notice. You may from time to time
update the information and change the selections made by You in this
Enrollment Agreement by written notice to the Enrolling Company or
through Hertz’ Internet website, http://www.hertz.com. This Enrollment
Agreement, as modified to reflect any changes which You may make to
the elections made by You on this form, is referred to as Your “Enrollment
for the United States and Canada. If accepted by Hertz, this Enrollment
Agreement will supercede any Enrollment Agreement submitted by You
which was accepted by Hertz prior to acceptance of this Enrollment
Agreement with respect to those countries. The supply of the information
requested on this form is voluntary. However, Hertz reserves the right
to reject Your application for membership if You do not supply all of the
information requested or for any other reason. See the General Provisions
for information regarding our use of personal data.
3. When You rent a private passenger motor vehicle (excluding trucks and
vans), including all such vehicles’ parts (a “Car”), in the United States
or Canada using Gold, the Hertz company or licensee providing the
Car is called the “Renting Company.” Your Enrollment for the United
States and Canada, together with the terms and conditions in the North
American Gold Rental Booklet (as modified by Hertz from time to time in
the manner prescribed therein), the rental record which You receive at
the commencement of the rental, and any other documents which You
are required to sign at the commencement of the rental, will constitute
the agreement between You and the Renting Company governing the
rental. The identity of the Renting Company for each rental will appear on
the Rental Record for that rental. The Enrolling Company and the Renting
Company are referred to collectively as “Hertz,” “we” or “us.
4. THE FOLLOWING INFORMATION IS PROVIDED
REGARDING YOUR RESPONSIBILITY FOR LOSS OF
OR DAMAGE TO ANY CAR WHICH YOU RENT IN THE
UNITED STATES OR CANADA USING GOLD. MORE
DETAILED INFORMATION APPEARS IN PARAGRAPH
4 OF THE NORTH AMERICAN TERMS. EXCEPT AS
STATED IN PARAGRAPH 4 OF THE NORTH AMERICAN
TERMS, YOU ARE RESPONSIBLE FOR ANY AND
ALL LOSS OF OR DAMAGE TO THE CAR RESULTING
FROM ANY CAUSE REGARDLESS OF FAULT. FOR
RENTALS IN THE UNITED STATES AND CANADA,
HERTZ OFFERS, FOR AN ADDITIONAL CHARGE, A
LOSS DAMAGE WAIVER (LDW). IF YOU ACCEPT LDW,
WHICH IS NOT INSURANCE, HERTZ WILL NOT HOLD
YOU RESPONSIBLE FOR LOSS OF OR DAMAGE TO
THE CAR, SUBJECT TO CERTAIN RESTRICTIONS
AND EXCLUSIONS WHICH ARE DISCUSSED IN
PARAGRAPHS 4(d), 4(e) AND 5 OF THE NORTH
AMERICAN TERMS. IN THOSE STATES WHERE THE
SALE OF LDW IS REGULATED OR PROHIBITED,
THAT LAW WILL GOVERN YOUR RESPONSIBILITY
FOR LOSS OR DAMAGE TO THE CAR. LDW ENTAILS
AN ADDITIONAL CHARGE. AS OF JANUARY 1, 2006,
THE CHARGE FOR LDW AT MOST LOCATIONS IN
THE UNITED STATES OR CANADA IS US$26.99
OR CAN$30.95, RESPECTIVELY, FOR EACH FULL
OR PARTIAL RENTAL DAY. HOWEVER, A SPECIAL
HIGHER LDW CHARGE OF US$34.99 OR CAN$34.95
FOR EACH FULL OR PARTIAL RENTAL DAY IS
APPLICABLE TO CERTAIN LUXURY CARS. ALL
CHARGES ARE SUBJECT TO CHANGE WITHOUT
NOTICE. YOUR OWN INSURANCE (OR THAT OF AN
AUTHORIZED OPERATOR) MAY COVER ALL OR
PART OF YOUR FINANCIAL RESPONSIBILITY (OR
THAT OF THE AUTHORIZED OPERATOR) FOR LOSS
OR DAMAGE TO THE CAR.
5. NOTICE: THIS CONTRACT OFFERS, FOR AN
ADDITIONAL CHARGE, A LOSS DAMAGE WAIVER
TO COVER YOUR FINANCIAL RESPONSIBILITY
FOR DAMAGE TO THE RENTAL VEHICLE. YOU ARE
ADVISED TO CAREFULLY CONSIDER WHETHER TO
SIGN THIS WAIVER IF YOU HAVE RENTAL VEHICLE
COLLISION COVERAGE PROVIDED BY YOUR
CREDIT CARD OR COLLISION INSURANCE ON
YOUR OWN VEHICLE. BEFORE DECIDING WHETHER
TO PURCHASE THE LOSS DAMAGE WAIVER, YOU
MAY WISH TO DETERMINE WHETHER YOUR OWN
VEHICLE INSURANCE AFFORDS YOU COVERAGE
FOR DAMAGE TO THE RENTAL VEHICLE AND THE
AMOUNT OF THE DEDUCTIBLE UNDER YOUR OWN
INSURANCE COVERAGE. YOU ARE ALSO ADVISED
TO DETERMINE WHETHER SUCH COVERAGE IS
PROVIDED UNDER THE AGREEMENT REGARDING
THE CREDIT CARD WHICH IS USED TO PAY FOR THE
RENTAL OR FROM ANY OTHER SOURCE AND, IF
SO, THE TERMS AND SCOPE OF SUCH COVERAGE.
THE PURCHASE OF A LOSS DAMAGE WAIVER IS
NOT MANDATORY AND MAY BE DECLINED.
6. THE INSURANCE COVERAGES OFFERED BY HERTZ
MAY PROVIDE A DUPLICATION OF COVERAGE
ALREADY PROVIDED BY A RENTER’S PERSONAL
AUTOMOBILE INSURANCE POLICY OR BY
ANOTHER SOURCE OF COVERAGE. THE PURCHASE
OF THESE KINDS OF COVERAGE IS NOT REQUIRED
IN ORDER TO RENT A CAR.
7. FOR RENTALS COMMENCING IN THE DISTRICT OF
COLUMBIA. WARNING: FAILURE TO RETURN THE
CAR IN ACCORDANCE WITH THE TERMS OF THE
RENTAL AGREEMENT MAY RESULT IN A CRIMINAL
PENALTY OF UP TO 3 YEARS IN JAIL.
8. Unless waived, a renter in Miami-Dade County must
be furnished a county-approved visitor information
map. These maps are available at all Hertz locations
in Dade County. Each renter must either acknowledge
receipt of such a map or waive his or her right to
receive such a map. By signing this Enrollment
Agreement, You hereby waive Your right to receive
such a map.
Hertz rents Fords and other fine cars.
® Reg. U.S. Pat. Off. © 20 07 Hertz System, Inc.
CUSTOMER’S CHOICE TO LIMIT USE OF DATA:
We are The Hertz Corporation and its subsidiaries (“Hertz”). To provide you with the opportunity to
participate in offers and services which we believe would be of interest to you, where legally permitted
and in accordance with our Privacy Policy, Hertz may send you mailings and disclose personally
identifiable data about you to Hertz’ affiliated companies, Hertz’ independent licensees and other
companies for their marketing purposes. Please read Hertz’ Privacy Policy. To obtain a copy of our
Privacy Policy for Rental Customers, please write to Director, Privacy Services, The Hertz Corporation,
P.O. Box 25301, Oklahoma City, OK 73125, or go to www.hertz.com.
You may limit the use or disclosure of personally identifiable data about you by checking one of the
boxes within each of A and B below.
A. You give Hertz permission to send you marketing offers or materials in the course of Hertz’ rental
businesses and to disclose personally identifiable data about you collected in the course of Hertz’
rental businesses to Hertz’ affiliates or licensees for marketing purposes.
M1. Postal Mail Only M2. E-Mail Only M3. Both Postal and E-Mail
M4. You direct Hertz not to send you any marketing offers or materials in the course of Hertz’
rental businesses and not to disclose personally identifiable data about you collected in the
course of Hertz’ rental businesses to Hertz’ affiliates or licensees for marketing purposes.
If you do not check any of the boxes above, you will be deemed to have selected item 1. If you check
item 4, you will not receive offers and services that may be of interest to you, including Hertz #1
Awards Points and free rental days provided under Hertz #1 Club Gold loyalty programs such as the
Five Star, President’s Circle and Manhattan Gold and Islander Gold programs.
B. M1. You give Hertz permission to disclose personally identifiable data about you collected in the
course of Hertz’ rental businesses to companies that are not Hertz’ affiliates or licensees for
marketing purposes.
M2. You direct Hertz not to disclose personally identifiable data about you collected in the
course of Hertz’ rental businesses to companies that are not Hertz’ affiliates or licensees for
marketing purposes.
If you do not check either of the boxes above, you will be deemed to have selected item 1.
U.S. OPTIONAL SERVICES/CAR CLASS:
If you do not accept or decline an optional service, you will be
deemed to have declined.
LDW Loss Damage Waiver Accept (initial) Decline (initial)
PAI/PEC Personal Accident Insurance and
Personal Effects Coverage Accept (initial) Decline (initial)
LIS Liability Insurance Supplement Accept (initial) Decline (initial)
(Rentals commencing in all states including California)
LIS* Liability Insurance Supplement Accept (initial) Decline (initial)
(Rentals commencing in California only)
THE CAR CLASS YOU WISH TO DRIVE: (Check one)
M COMPACT, 4-DOOR M MID-SIZE M SPORTY, 2-DOOR
MFULL-SIZE, 4-DOOR M PREMIUM M LUXURY M SUV, 4-WHEEL DRIVE
*If you accept LIS for rentals commencing in all states, you must also accept LIS for California rentals only.
CANADA OPTIONAL SERVICES/CAR CLASS:
If you do not accept or decline an optional service, you will be deemed
to have declined.
LDW Loss Damage Waiver Accept (initial) Decline (initial)
PAI/PEC Personal Accident Insurance and
Personal Effects Coverage Accept (initial) Decline (initial)
THE CAR CLASS YOU WISH TO DRIVE: (Check one)
M COMPACT, 4-DOOR M MID-SIZE M SPORTY, 2-DOOR
MFULL-SIZE, 4-DOOR M PREMIUM M LUXURY M SUV, 4-WHEEL DRIVE
ELECTIONS FOR U.S. AND CANADA:
These options apply to both the U.S. and Canada.
NON-SMOKING/SMOKING OPTION: (Check one)
M NON-SMOKING CAR M SMOKING CAR M NO PREFERENCE
M HERTZ NEVERLOST
®
GPS NAVIGATIONAL SYSTEM: If you have selected a Mid-Size or
larger vehicle, you may check here if you prefer a vehicle equipped with Hertz NeverLost
®
(where available). An additional daily charge applies.
M SIRIUS SATELLITE RADIO: Check here if you prefer a vehicle equipped with SIRIUS (subject to
availability). An additional charge applies.
SIGNATURE (must sign to enroll):
BE CERTAIN TO COMPLETELY FILL OUT EACH SECTION AND SIGN BEFORE MAILING.
The Hertz #1 Club Gold Rental Terms and Conditions for rentals in the United States and Canada (the “North American Gold
Rentals Booklet”) will be mailed to you with your Gold membership card. You agree that your first Gold rental will constitute
your acceptance of the terms and conditions which appear in the North American Gold Rentals Booklet. If you do not agree to the
terms and conditions which appear in the North American Gold Rentals Booklet, you should promptly return your Hertz #1 Club
Gold membership card for cancellation. YOU ACKNOWLEDGE THAT YOU HAVE RECEIVED, READ, UNDERSTAND AND AGREE TO THE
TERMS, CONDITIONS, DISCLOSURES AND NOTICES, CONSISTING OF 16 SECTIONS, WHICH COMPRISE THE NORTH AMERICAN
ENROLLMENT AGREEMENT TERMS, INCLUDING BUT NOT LIMITED TO THE NOTICES IN SECTIONS 4 THROUGH 11 THEREOF.
M Simply check here to request additional information from Hertz about Gold rentals in Europe, Middle
East, Africa, Australia and New Zealand.
HERTZ #1 CLUB
®
NUMBER
(IF APPLICABLE)
HERTZ CDP NUMBER
(IF APPLICABLE)
ACCOUNT NAME OF CDP NUMBER (IF APPLICABLE)
NAME & ADDRESS
MMr. M Mrs. MMs. MDr. M Other
FIRST M.I. LAST
HOME ADDRESS
HOME ADDRESS (CONTINUED)
CITY, STATE/PROVINCE, ZIP/POSTAL CODE
COMPANY NAME
COMPANY ADDRESS
COMPANY ADDRESS (CONTINUED)
CITY, STATE/PROVINCE, ZIP/POSTAL CODE
Preferred address for correspondence: M Home M Business
TELEPHONE M Home ( )
M Business ( )
FAX ( )
PREFERRED E-MAIL ADDRESS
PERSONAL INFORMATION (mandatory for enrollment):
DATE OF BIRTH / /
(Must be at least 21 years of age) MO. DAY YR.
DRIVER’S LICENSE NUMBER
STATE/PROVINCE EXPIRATION DATE / /
MO. DAY YR.
In order of preference, list up to 3 credit or debit cards you wish to use for #1 Club Gold rentals.
The billing address for the cards must be one of the addresses you list above. At least one card
must be entered in order to enroll. A minimum of two cards, including at least one credit card,
is recommended. Some Hertz locations do not accept debit cards to qualify for rental. Your
membership fee, if applicable, will be charged to the first card listed below which has sufficient
available credit or funds.
TYPE OF CARD NUMBER EXPIRATION DATE
1.
2.
3.
ENROLLMENT AGREE MENT
To enroll in Hertz #1 Club Gold
®
for rentals in the U.S. and Canada, just complete the short form below and return it in the enclosed envelope.
Or, simply fax your completed form to us at: (405) 290-2200. Read the North American Enrollment Agreement Terms, which are part of this
Enrollment Agreement, and the Summary of Optional Services, which accompany this Enrollment Agreement, before completing this form.
Enrolling Company: The Hertz Corporation,
PO Box 26280, Oklahoma City, OK 73126-9804
4683 SNPEA06/0607
X
YOUR SIGNATURE (MUST SIGN TO BE ELIGIBLE.) DATE
FEE WAIVED
Offer Expires: December 31, 2008