1Choose a Vehicle2Personal Information3Documentation4Payment Information Pick-Up Date* MM slash DD slash YYYY Drop-Off Date* MM slash DD slash YYYY Make a Selection* 2DR Jeep Wrangler Classic 2DR Jeep Wrangler Premium Ford Escape Ford Bronco Jeep Cherokee 4DR Jeep Wrangler Classic 4DR Jeep Wrangler Premium Dodge Durango Ford Explorer Number of Cars12345678910Please Select Additional Cars Here: 2DR Jeep Wrangler Classic 2DR Jeep Wrangler Premium Ford Escape Jeep Cherokee 4DR Jeep Wrangler Classic 4DR Jeep Wrangler Premium Dodge Durango Ford Explorer Choose Your ExtrasExtras can be added or removed at the time of check-in. Additional Driver - $5 per day Car Seat - $5 per day Roadside Assistance - $5 per day Convenient Gas Charge - $20 one time International Driver's Permit - $30 one time Intown Parking - $0 Insurance Waiver is automatically included and can be removed by providing proof of rental car insurance coverage in the US Virgin Islands, operating a 4x4 sports-utility vehicle. Please keep in mind that you always have the opportunity to change your coverage selections at the counter when you pick up your car. 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Proof of Insurance Drop files here or Select files Max. file size: 24 MB. Example: Example: Car Insurance Company NameExpiration Date MM slash DD slash YYYY Policy NumberInsurance Company Phone NumberInsurance Confirmation* I will have a valid Insurance card at the time of pick-up and accessible while operating Rental*If waived, proof of Insurance and verification of coverage in the US Virgin Islands, operating a 4x4 sports-utility vehicle is required. Renter(s) are liable for the full amount of the Rental. If Courtesy Car/Jeep Rental’s collision, personal accident, and liability insurance ($15 per day) is purchased, Renter’s liability is reduced to $1,500.If waived, proof of Insurance and verification of coverage in the US Virgin Islands, operating a 4x4 sports-utility vehicle is required. Renter(s) are liable for the full amount of the Rental. Please note, if you wish to use the auto insurance offered by your credit card company, credit card companies usually require that you use the same credit card for the deposit and remaining balance of the Rental. If Courtesy Car/Jeep Rental’s collision, personal accident, and liability insurance ($15 per day) is purchased, Renter’s liability is reduced to $1,500.Flight InformationHave you booked your flight?NoYesArrival Date MM slash DD slash YYYY Airline NameFlight NumberFlight Arrival Time Secure Credit Card Type*VisaMaster CardAmerican ExpressCredit Card Number*Credit Card Number*Expiration Month*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Year*Card Verification Number (CVN)*Authorization AgreementI authorize Courtesy Car & Jeep Rental, Inc. (“CCR”) to charge the credit card listed above a deposit in the amount of $100.00 by the Customer listed on reservation. CCR will provide a detailed statement within 48 hours. I certify that I am authorized to sign this form on behalf of the Renter’s Name. This information will be maintained securely by CCR. I understand that if I need to cancel this reservation I will need to give a two (2) weeks-notice prior to arrival for my deposit to be refunded. I agreeSpecial Requests Δ