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Thanks for your interest in a CarShare Vermont membership.

Please complete all required fields in the form below. If you have any questions during this process, call us at (802) 861-2340.
This Additional Driver application will be associated with an existing Household or Organizational Account.

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

New Applicant - Member Application Form

Monday, April 27, 2015
Driver
Choose a Password & PIN

Please select a password to be used for online reservations, and a PIN for telephone reservations.

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Personal Contact Information
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Emergency Contact Information
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Driver Record Information

A routine check of your driving record will be made to process your application. For the past three years, indicate the number of incidents you have had:
  • Moving violations (speeding, other traffic tickets)?
  • Reported accidents where you were fully or partially at fault?
  • Driving while under an influence (DUI) convictions?
 *How many moving violations have you had in the past 3 years?
 *How many at fault accidents have you had in the past 3 years?
YesNo * Have you had any alcohol related violations in the past 7 years?
Current License
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Choose Date  
Choose Date   *
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Check this box if within the past 2 years you had a driver's license issued by a state other than the state issuing your current license
Promotions
Promotion:  
Referrals and Promotions
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College Affiliation if Applicable
Verification

Applying to CarShare Vermont is the first step toward becoming a member. You are not eligible to drive a CarShare Vermont vehicle until you have been approved.


By submitting this application,

  1. I certify that everything stated in this application is true to the best of my knowledge.
  2. I authorize CarShare Vermont to retain this information for their use whether or not my application is approved.
  3. I authorize CarShare Vermont to check my driving record to assist in determining my acceptance for membership. CarShare Vermont may review my driving record(s) without notice at any time to determine my ongoing eligibility to be a member.
  4. I certify that I am at least 21 years of age OR that I am 18-20 years old and will sign the Young Driver Membership Agreement, which provides financial protection via a co-signer on the account until I reach the age of 21. I understand that if I have misrepresented my age, I will be immediately disqualified from use of CarShare Vermont's insurance and upon discovery of such information, CarShare Vermont will terminate my membership.
  5. I agree to be bound by this application and CarShare Vermont's Member Agreement, and I understand that failure to disclose my violations or accidents may cause automatic rejection of this application.
  6. I have reviewed the eligibility requirements of CarShare Vermont and believe I am eligible for membership. I agree that a nonrefundable $30 Application Fee (unless discounted by valid promotional code) will be charged to the credit card associated with the application form above, regardless of my acceptance for membership.
  7. I agree to be bound by the policies outlined in the CarShare Vermont Member Handbook, and to drive responsibly. I understand that this document may be changed at any time without notice, and that if I do not drive responsibly I may be responsible for fines, fees, penalties.
  8. I understand that I am applying as an additional driver on a household account, and that all refunds on the account will be made payable to the main member only. I will not allow anyone who is not an authorized member of CarShare Vermont to drive a CarShare Vermont vehicle.


I understand and accept
 
 

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