It is NOT necessary to complete the form if:

• You are under the age of 25, because you MUST purchase supplemental liability and collision damage insurance through the rental agency
• You are renting through Browns Preferred Suppliers through the Travel Portal using our contract numbers, because all insurance is automatically built into the cost of the rental. 

Name: *

Title: *

Choose One: *

Faculty

Staff

Graduate Student

Undergraduate Student

Other

Email Address: *

Explanation why preferred suppliers are not being used: *

Please check here if you are under the age of 25:

Under 25

You understand that if there is an accident involving a rental vehicle, the department will bear a portion of the loss (deductible) up to $2,000. Physical damage deductible of $1,000 and/or liability (if another vehicle is involved) deductible of $1,000: *

Yes