Company Information |
| Company Name: |
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| Claim Rep. Name: |
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| Claim Rep. Phone: |
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| |
Please include area code. |
| Claim Number: |
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| E-Mail Address: |
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Insured/Claimant Information(Renter) |
| Renter's Name: |
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| Renter's Phone: |
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| E-Mail Address: |
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Assignment Details |
| Vehicle Type: |
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| Pick Up: |
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| Drop Off: |
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| Location: |
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Return Location:
(if different) |
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| Daily Rate |
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| Maximum amount authorized($): |
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| Notes: |
If an insurance rental has already been made and you would like to make adjustments, please contact our Reservations Center at (317)844-3700. Also feel free to email any adjustments to reservations@thriftyindy.com |
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| Filling out this field
will result in your form being rejected. |
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