Auto Rental Safety Product Order Form

Auto Rental Safety Product Order Form

FREE FOR POLICYHOLDERS ONLY!!!
Don't get caught short!
Make sure you have the loss prevention & safety tools you need!

Please use this form to order extra:

•	Accident Reporting Pads
•	Insurance Change Form Pads
•	Emergency Instruction Laminated Visor Cards
•	"Before You Leave" Rental Customer Safety CD
•	"The Right Driver Every Time" CSR Training Video

Accident Reporting Pads
Insurance Change Form Pads
Emergency Instruction Laminated Visor Cards
"Before You Leave" Rental Customer Safety CD
"The Right Driver Every Time" CSR Training Video
Please send me more of the following FREE items:
Accident Reporting Pads: qty.	Insurance Change Form Pads: qty.
Emergency Instruction Laminated Visor Cards: qty.
"Before You Leave" Rental Customer Safety CD: qty.
"The Right Driver Every Time" CSR Training Video: qty.

Your Name:
Policy Number:
Company:
Company Address:
P.O. Box:
City:
State:		Zip:
Tel:	( )
Fax:	( )
E-mail:

Please click on the "submit" button below to send this form electronically.
For any questions please call our Customer Service Department at
1-800-782-8902 ext. 3307