Master Rental Agreement Profile

MASTER RENTAL AGREEMENT PROFILE
To enroll in The Emerald Club®, simply fill out this form electronically, print and sign. Completed forms may be emailed to
Title / First Name (Given Name) / MI / Last Name (Surname)
Address - Line 1 / Address - Line 2
City / State/Province / Country
ZIP/Postal Code / Daytime Telephone / Home Telephone
- / - - / - -
Email Address / Email Format Preference: / E-Receipt:
HTML Text / Yes No

I authorize National®, its licensees and affiliates to communicate with me via: Email Postal Mail

I authorize National and its marketing partners to communicate with me via: Email Postal Mail

Contract ID Number / Company Name / Date of Birth (dd/mm/yyyy)
XZ50386
Driver’s License Number / Expiration Date (dd/mm/yyyy) / Issuing Country
Rewards
My reward preference is: Rental Credits
Please provide the major credit card(s) you would like on your profile. Please note that National does not accept debit cards. / Credit Card / Code
American Express® / AX
Carte Blanche / BL
Code / Credit Card Number (Please provide entire number) / Expiration Date (mm/yyyy) / Discover® Card / DS
JCB International / JC
MasterCard® / MC
Code / Credit Card Number (Please provide entire number) / Expiration Date (mm/yyyy) / National Charge / CB
Visa® / VI
Optional products and benefits, where available, for renting in:
U.S. / LDW: / PAI/PEC: / SLI: / Roadside Plus:
Accept Decline / Accept Decline / Accept Decline / Accept Decline
Canada / LDW: / PAI/PEC: / POM: / Roadside Plus
Accept Decline / Accept Decline / Accept Decline / Accept Decline
Europe / CDW: / TP/TW: / PAI:
Accept Decline / Accept Decline / Accept Decline
Global / Upfront Fuel: / GPS:
Accept Decline / Accept Decline
I agree to the Emerald Club General Program Rules and Conditions, which includes the Terms and Conditions of the Master Rental Agreement (MRA), as amended from time to time, for each rental under The Emerald Club. I understand and agree that any additional information or revised information on this document will become part of my MRA Profile for all future rentals under the program. I have received and read a paper copy of the Emerald Club General Program Rules and Conditions, including its Terms and Conditions of the Master Rental Agreement, or have read a copy of this document online at the nationalcar.com Web site. I read this document on the date I signed this MRA Profile. I understand and agree to be bound by all of the terms and conditions of the Emerald Club General Program Rules and Conditions (and its Terms and Conditions of the Master Rental Agreement, including the accompanying notices regarding National’s Loss Damage Waiver (LDW) and insurance products), this MRA Profile and my selections of optional products, all of which together form my MRA. I waive my right to receive a Miami-Dade County Visitor Information map at the time this MRA is executed. The collection, use and disclosure of the information that I provide to National Car’s Emerald Club is governed by National’s Privacy Policy, which is available upon request, and I consent to the collection, use and disclosure of my personal information by National Car’s Emerald Club for the purposes outlined in the Privacy Policy.
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Signature Date