Car Share Registration

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

A $25 application 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

Personal Contact Information
First Name* Last Name*
Address*
City* State* Zip Code*
Email*
Work Email*
Home Phone* Work Phone Cell Phone
Date of Birth* Gender
Emergency Contact Information
First Name* Last Name*
Telephone Number* Cell Number*
Relation to you*
Current License (You must have a valid driver's license to apply for membership)
Current License Number*
Issued By*
Date Issued (Leave blank for licenses without a date of issue.)
Expiration Date* Years Driving*
Driving History
Accidents within the last 3 years*
Traffic Violations within the last 3 years (excluding parking tickets)*
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 EZ Ride ?
If you've been thinking about buying or leasing a car, would you consider not buying or leasing if EZ Ride works well for you?
How do you plan to use EZ Ride ?
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 EZ Ride is authorized to retain this information whether or not my application is approved.
  3. I authorize EZ Ride and their insurance provider to check my driving record.
  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:

graphic of waves