Driver Application

Full Name

Address

Street Address

City

State

Country

Postal Code

Years at Address

Phone *

Email *

Date of birth

Application Type

Additional Fee Charged

Driving History

License Number:

Issue State

Expiration Date:

Miles Driven Per Year:

Ever had license suspended/revoked/refused?

Yes

No

if Yes, please explain:

Convicted of DUI or Drug Influence?

Yes

No

If Yes, please explain:

Incident Details

Date of Most Recent Incident:

Who was at fault?

You

Driver

Someone else

Type of Violation:

Describe the Incident:

Driving Experience & Insurance

Do you have automobile insurance?

YES

NO

Have you driven a van?

YES

NO

Anything that would interfere with your ability to drive?

YES

NO

If yes, describe:

APPROVAL INFORMATION

Approved

Not Approved

Driver Agreement

By checking this box, and submitting this application, I confirm that I:

Maintain a valid driver’s license
Will report accidents and citations within 48 hours
Will not use the vehicle for unauthorized activities
Will keep vehicle clean and serviced
Will not use a phone while driving
Understand and agree to follow all First Choice safety rules

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

Privacy Policy | Terms of Service

Contact Us

Mon-Fri 7am-6pm

301-542-4280

[email protected]

SCHEDULE NOW