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OTA CAR CARE CENTER LOANER CAR VIRTUAL FORMS
**When you are done filling out this form, please email a photo of your license AND your auto insurance information to
otaloanercars@gmail.com
to complete your request. If we do not receive a photo of your license and your insurance information, you will not be able to get your loaner car.**
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* Indicates required question
Email
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Your email
Today's Date
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MM
/
DD
/
YYYY
Customer First and Last Name
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Your answer
Home Address (Street, City, State, Zip)
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Your answer
Home Phone Number
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Your answer
Cell Phone / Business Phone
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Your answer
Driver's License #
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Your answer
Driver's License State and Expiration Date
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
ONLY FILL THIS OUT IF YOU INTEND ON HAVING AN ADDITIONAL DRIVER ON THE LOANER CAR: Additional Driver Name, Address, City, State, Zip, Driver's License Number, Expiration Date and Date of Birth....If no additional driver, put N/A
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Your answer
Customer's Insurance Company
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Your answer
Customer's Insurance Phone Number
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Your answer
Customer's Insurance Agent & Agent Phone Number
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Your answer
Please initial below to confirm you will not drive your loaner vehicle outside of 50 miles radius of OTA Car Care Center
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Your answer
Please initial below to confirm that you understand that New Jersey requires that every child 8 years or younger and weighing less than 80 pounds be transported in the back seat of the vehicle in a child passenger restraint system or booster seat that meets federal standards. You are responsible for supplying a child safety seat or renting one from us.
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Your answer
Please initial below to agree that you will complete a walkaround inspection of your loaner car before driving.
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Your answer
Click this link
https://oldtimeauto.com/loaner-terms%26conditions
to read the terms & conditions associated with this rental process. Please initial below to state that you have read the terms & conditions.
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Your answer
You must return the loaner car with a full tank of gas. Please make sure to clean out the vehicle and leave NO garbage behind. No pets are allowed in the vehicle at any time. You must bring your own EZPass if needed. You must stay within 50 miles radius of OTA. You understand that in the event of an accident, your insurance is first and OTA is secondary. NO EATING, SMOKING, DRINKING IN THE LOANER CARS. $50 Charge if you do not fill the tank or top it off, $150 charge for detailing if food, smoke remnants, or pet hair is found in the vehicle. PLEASE INITIAL BELOW TO AGREE TO THESE RULES.
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Your answer
Please type your first and last name here as your VIRTUAL SIGNATURE agreeing to all listed in this form
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Your answer
A copy of your responses will be emailed to the address you provided.
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