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Thanks for your interest in joining CarShare Vermont! This application is to enroll in our subsidized MobilityShare program for qualifying low-income individuals and families. Before taking the time to fill out the application, please make sure that you meet all program requirements. If you have any questions, call us at (802) 861-2340.

For your first year of membership, the Share-a-Lot annual plan fee will be waived ($150 value). Your subsidized MobilityShare membership expires one year from your activation date (not your application date). If you would like to continue a CarShare Vermont membership beyond your first year, please contact us before the expiration date to enroll in one of our standard rate plans.

Please complete all required fields on this form. If you have any questions during this process, please call us during normal business hours at (802) 861-2340 or email us at info@carsharevt.org.


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

New Applicant - Member Application Form

Monday, April 27, 2015
Joint
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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Payment Information
Credit Card Information
  • You must have a credit card to be eligible for CarShare Vermont membership. An authorization (not a charge) of $1.00 will be attempted on the credit card you submit below simply to verify that it is valid.

Payment Method: Credit Card

Card Number:    *
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Check this box if your Credit Card Address is different from your Primary Address
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
Deductible Waiver Program (Click here for more information)
Terms and Conditions

By Enrolling in the Deductible Waiver Program I understand that:

  • I must report any damage that occurs during my reservation immediately by calling the CarShare Vermont Emergency Line at 802-999-2006
  • To be eligible I must remain a member in good standing by not violating the Member Handbook and be current on all driving estimate payments and/or monthly invoice payments;
  • I am not purchasing, nor is CarShare Vermont selling, insurance through this agreement;
  • Only the Account Authority can enrol in the Annual Deductible Waiver Program;
  • Enrolment in the Annual Deductible Program applies to all drivers on an account; there is a $45 charge for each driver;
  • The Hourly Option is also available to a member who has already used their once per year benefit while enrolled in the Annual Option.

The Deductible Waiver Program does NOT include any loss arising directly or indirectly from:

  • Unreported Damage to a CarShare Vermont vehicle or another party’s vehicle;
  • Damage caused to a vehicle when a CarShare Vermont driver fails to stop and properly report an accident (hit and run)
  • Members whose account is not up to date or who have an overdue payment;
  • Members who falsify or provide misleading information to CarShare Vermont staff investigating damage to a CarShare Vermont vehicle
  • Damage that occurs prior to signing up for the Program
  • Intentional damage to a vehicle by a member
  • Fees or Penalties you incur according to the Member Handbook
  • Any violation of the Member Handbook
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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. 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 (refer to the CarShare Vermont Member Handbook), 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, as well as the MobilityShare program requirements and believe I am eligible for membership through the MobilityShare program. 
  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, and penalties.
  8. I understand that I take full responsibility for any additional drivers who join this account, including liability for all charges, fees, and other responsibilities incurred by these other drivers. I also understand that any refunds on this account will be made payable to me only. 
  9. I will not allow anyone who is not an authorized member of CarShare Vermont to reserve or drive a CarShare Vermont vehicle. 
  10. I understand that CarShare Vermont will verify my eligibility to participate in MobilityShare and that any misrepresentation will result in termination of my membership and/or applicable fees.
  11. I understand that by participating in CarShare Vermont's MobilityShare program, my membership will be subsidized for one year, including discounted driving rates. After this time I may enroll in one of CarShare Vermont's other membership plans and pay the associated fees and driving rates, or I may terminate my membership.
  12. I will participate in surveys and share information with CarShare Vermont about my MobilityShare membership. I understand that this information will be used to evaluate the effectiveness of the program and to attempt to secure future funding to support it.


I understand and accept
 
 

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