Rideshare Rental Application

Review vehicle terms, complete your application profile, provide consent, and finalize payment.

Selected Vehicle

Chrysler Pacifica

Comfort-first minivan with flexible seating and family-friendly cargo options.

Deposit: $499

Weekly plan$499

Minimum term2 weeks

ContractFlexible terms

Rental price includes preventative maintenance.

Complete your rideshare rental application

Provide complete details so our team can review your application and continue to secure payment.

First name

Last name

Phone

City

State

ZIP

Identity verification, driver license details, SSN, and formal screening authorization are completed securely in Checkr after the deposit step. This form only captures the contact and underwriting basics needed to start review.

Employment & housing profile

Employment status

Months at current job

Income range

Housing status

Prior bankruptcy

Prior repossession

Rideshare platform

Preferred start date

Credit check required for your rental

By checking the box, you authorize Advance Van Rental to review your submitted information for rental eligibility decisions. This is a consent acknowledgment only and does not guarantee approval.

I authorize Advance Van Rental to review submitted information for rental qualification.

Background screening authorization

With your consent, Advance Van Rental may use a screening partner to review eligibility information. Authorization does not guarantee approval.

- National, federal, county, and state criminal screenings
- Sex offender registry check
- Global watchlist records check
- Drug and health screenings
- Motor vehicle records (MVR)
- Personal and professional reference checks
- Education verification
- Employment verification
- Continuous criminal screenings
- International screenings

I authorize Advance Van Rental to request background screening reports for rental qualification.

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