Master Rental Agreement Profile Update Form - National Emerald Club printable pdf download

MASTER RENTAL AGREEMENT PROFILE UPDATE

To update your Emerald Club

profile simply fill out the required fields marked with an asterisk and the information to be

updated electronically, print and sign. Completed form should be faxed to (00 1) 918-401-8293.

Title

First Name (Given Name)*

Last Name (Sur-name)*

Address - Line 1

Address - Line 2

City

State/Province

Country

ZIP/Postal Code

Primary Telephone

Secondary Telephone

Email Address

E-Receipt:

Yes

*EMERALD CLUB#__________________

Yes, I’d like to make the most of my membership by receiving member emails.

Yes, I’d like to receive special email offers and information from select partners.

Contract ID # (if known)

Company Name

Date of Birth (MMM/DD/YYYY)

Driver’s License Number

Expiration Date (MMM/DD/YYYY)

Issuing State/Province

You have the option of receiving rental credits or frequent traveler points/miles. A

Frequent Traveler Surcharge

may apply. Entering your Frequent Traveler number is

considered an acceptance of this fee.

My reward preference:

Rental Credits or

Frequent Traveler Points/Miles

Program

Code

Program

Code

Frequent Traveler Number

American Airlines®

Signature Tailwins

AIR MILES® Reward Program

Jet Airways (India)

Alaska Airlines

Korean Airlines

Frontier Airlines

Southwest Airlines

ANA

Virgin America

Asiana

US Airways®

Air China

Wyndham®

China Eastern Airlines

Carlson Hotels

Delta Air Lines

Hilton Worldwide

EVA

More Rewards

Hawaiian® Airlines

Enterprise Plus

E+

Credit Card

Code

Please provide the major credit card(s) you would like on your profile. Please note that

National does not accept debit cards.

American Express

Code

Primary Credit Card Number (Please provide entire number)

Expiration Date (MM/YYYY)

MasterCard

Visa

National Charge

Code

Secondary Credit Card Number (Please provide entire number)

Expiration Date (MM/YYYY)

Discover

Card

Optional products and benefits, where available, for renting in:

U.S.

LDW:

PAI/PEC:

SLI:

Roadside Plus:

Decline

Canada

LDW:

PAI/PEC:

POM:

Roadside Plus

Decline

Global

Upfront Fuel:

GPS:

Decline

I agree to the Emerald Club General Program Rules and Conditions, which includes the Terms and Conditions of the Master Rental Agreement (MRA), as amended from time to time, for each

rental under The Emerald Club. I understand and agree that any additional information or revised information on this document will become part of my MRA Profile for all future rentals under the

program. I have received and read a paper copy of the Emerald Club General Program Rules and Conditions, including its Terms and Conditions of the Master Rental Agreement, or have read a

copy of this document online at the Web site. I read this document on the date I signed this MRA Profile. I understand and agree to be bound by all of the terms and conditions of

the Emerald Club General Program Rules and Conditions (and its Terms and Conditions of the Master Rental Agreement, including the accompanying notices regarding National’s Loss Damage

Waiver (LDW) and insurance products), this MRA Profile and my selections of optional products, all of which together form my MRA. I waive my right to receive a Miami-Dade County Visitor

Information map at the time this MRA is executed. The collection, use and disclosure of the information that I provide to National Car’s Emerald Club is governed by National’s Privacy Policy, which

is available upon request, and I consent to the collection, use and disclosure of my personal information by National Car’s Emerald Club for the purposes outlined in the Privacy Policy. Full Terms

& Conditions can be found at

______________________________________________________________________________________

___________________________________________

Signature*

Date*

Last Updated 10/2014