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