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Application for Rental

Rental Rates

Weekly $100 (7 days)

 Weekend $75 (Fri-Mon)

Extra Days $18.50 each

Installation $50 (mount and dismount)

All trucks having a 3rd brake light, require a functional brake light in the topper

Pick up Date       /       /

Thru

Return Date        /         /

All returns must be by 4:00 pm (2:00 pm on Sat.) on the due date

Security Deposit

Aluminum Tops $350.00 — Credit Card or Cash (Fiberglass $500)

Deposit will be refunded when topper is returned and inspected for damage

Personal Information

Name:

 

Drivers License#

Address:

Social Security#

City:

State:

Zip:

Home#:

Work#:

Other#:

Employer:

Employer Address:

City:

State:

Zip:

Truck Information

Year:

Make:

Model:

Description:

Vehicle Tag#

 

Insurance Company:

Agent:

Policy#

 

Customer must notify insurance company regarding use and coverage of this product

Customer Notice

All Rental Tops are clamped on the truck bed rails. Be aware that the truck bed rails, cab and rear window area, cargo/3rd brake light, and tailgate are all subject to superficial damage and or abrasion.  DFW Camper Corral assumes no liability for any of this possible wear associated with the installation, use, or removal of this product.  This product is not intended to serve as a passenger compartment.  Do not occupy pickup truck bed while the engine is running or the vehicle is moving.  SERIOUS OR FATAL INJURY may occur from collision or carbon monoxide poisoning.  Customer accepts full liability for any and all damaged caused to the Rental Top.

Customer Signature:

Date: