CAR RENTAL RECEIPT

Date: _______________________

Receipt #: _______________________

Rental Company Info Lessee Info

Company: _______________________ Name: _______________________

Representative: ______________________ License #: _______________________

Location: _______________________ Address: _______________________

City/State/ZIP: _______________________ City/State/ZIP: _______________________

Phone: _______________________ Phone: _______________________

Vehicle Information
VIN: _______________________ Registration #: _______________________

Make: _______________________ Model: _______________________

Year: _______________________ Mileage: _______________________

Color: _______________________

VIN Cost/Day # of Days Additional Costs Line Total

Payment Method: Subtotal:

Cash. Check. No: _______________ Tax ( %):

Credit. No: _______________ Total:
Other. _______________
Amount Paid:

Authorized Signature: _______________________

Representative Name: _______________________

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