Member Name (as it appears on your driver's license)
RECC Service Address
Terms of Agreement
By checking this box, I have read and agree to the terms of this Temporary Loan of Electric Vehicle Agreement, and represent all statements made herein and are true and correct. I understand that by typing my full name below and pressing the Submit button, this application will be stamped with today's date and authoried by me as if I had signed my Signature.