Carshare Registration

Thanks for your interest in membership with EZRide. To ensure a timely application process, complete all required fields in the form below.

A $25 processing fee will be charged to cover the cost of checking your driving record and processing.

* indicates a required field. The application will not be processed without this information.

New Applicant - Member Application Form

Application Information

Member Name:
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Buisness Address:
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Personal Contact Information
First Name:
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Last Name:
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Address:
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Address (cont):
City:
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State:
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Zip Code:
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Email:
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Work Email:
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Home Phone:
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Work Phone:
Cell Phone:
Date of Birth:
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Gender:
Emergency Contact Information
  
First Name:
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Last Name:
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Telephone Number:
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Cell Number:
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Relation to you:
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Current License
Instruction: You must have a valid driver's license to apply for membership
Current License Number:
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Issued By:
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Date Issued:
Blank for licenses without a date of issue.
Expiration Date:
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Years Driving:
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Just a Little More Information  
How many miles do you drive each year?
If you currently own a car would you consider giving it up after joining EZRide?
If you've been thinking about buying or leasing a car, would you consider not buying or leasing if EZRide works well for you?
How do you plan to use EZRide?
Verification  

By submitting this application,

  1. I am certifying that everything stated in this application is true to the best of my knowledge.
  2. I understand that EZRide is authorized to retain this information whether or not my application is approved.
  3. I understand that EZRide is authorized to check my driving record and insurance score.
  4. I understand that this application and all of the above consumer reports will be used to determine my acceptance for membership.
  5. I agree to be bound by this application and understand that failure to disclose my violations or accidents will cause automatic rejection of this application.

I understand and accept:

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