Automobile Use Authorization Owner Borrower Name Name Address Address City City State State Zip Code Zip Code Country Country Vehicle Description Make Reg'n Model VIN Color Year Duration of Agreement (From) (Through) Borrower agrees to pay for incidental repairs such as flat tires, etc. The parties agree that major damage, reimbursement for insurance deductibles, loss of No Claims etc. shall be reimbursed as outlined below. Other terms: maximum allowable miles to be driven, operating radius, etc. The Owner identified above authorizes the borrower to operate this vehicle subject to any terms agreed to on this document. Owner's Signature and Date The Borrower agrees to operate this vehicle subject to any terms agreed to on this document. Borrower's Signature and Date