Pioneer Trailer Rentals, LLC.

First Name................................................................
Last Name................................................................
Address1.....................................................................
Address2.....................................................................
City.............................................................................
State...........................................................................
Zip...............................................................................
Home Phone............................................................
Cell Phone................................................................
Driver's License Number........................................
Date of Birth (Minimum of 25)................................
How long have you lived at present address?...
If at present address less than 3 years include previous address here:
Address...................................................................
City...........................................................................
State.........................................................................
Zip............................................................................
Employer....................................................................
Employer Phone.......................................................
Number of people in your camping party?...........
Email Address...........................................................

Tow Vehicle Information:

Make.......................................................................................
Model......................................................................................
Year.........................................................................................
Color.......................................................................................
Engine Size...........................................................................
License Plate #.....................................................................
State........................................................................................
Are you the owner of this tow vehicle? Owners Name:	Yes No
Does your vehicle have a Tow package that includes a receiver hitch, 7-Pin round RV electrical connection, and trailer brake controller?	Yes No
Trip Destination (enter nearest City, State).......................
All vehicles will be inspected prior to departure. No extreme lift kits or monster trucks.

Insurance Information:

Policy #....................................................................................
Company................................................................................
Phone......................................................................................
Your coverage must include liability, comprehensive, and collision of the trailer being pulled. This can generally be added to your coverage for a small fee.
Are you able and willing to provide copies of your current driver’s license, registration, and auto insurance policy?	Yes No
Are you aware that towing a trailer may affect the handling characteristic of the tow vehicle? For example the vehicle may accelerate and decelerate more slowly, not turn corners as well, and you may experience decreased visibility while towing.	Yes No

General Rental Policy:

If you cancel your reservation, even long in advance, we reserve the right to charge 8% of the originally scheduled trip as an administration fee. A 15% cancellation fee may be applied if cancellation notice is less than 14 days. You must notify Pioneer Trailer Rentals in advance if you need to return early or you desire to extend your trip. Extensions are only considered if the trailer is available, enough notice is given, and payment is received. If you return early you will be charged 30% of the daily rate. If Renter returns late without giving an advance notice he/she can expect to pay the daily rate plus 15% for each late day.	Acknowledged
There is a required cleaning/ damage deposit. All trailers go out clean and are expected to return clean. Holding tanks must be dumped prior to returning trailer. No pets. No smoking in the trailer.	Acknowledged
If you are on a long trip and propane runs out before your scheduled return you are expected to service it at your cost. In cold climates the heater must be on and set at a minimum setting to keep any plumbing from freezing.	Acknowledged
For hunting parties that schedule a 10-day trip there will be a minimum charge of 7 days if you return early. Scheduled 7-days trip has a minimum charge of 5 days. A scheduled 5-day trip has a minumum charge of three days. We understand that you may have to return early to process game, however it is best to accurately forecast your trip duration. This will help us schedule future customers. Please do not store any game inside our travel trailers.	Acknowledged
I/We declare that the information is true and correct to the best of our knowledge, and that we give Pioneer Trailer Rentals permission to verify our background information that was provided on this application.	Yes No
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