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Thank you for your interest in a Community Car membership. Please complete all required fields in the application form below.

Before submitting your application:
1. Review our eligibility requirements
2. Choose a rate plan

Application Fee:
When you submit your application, a $35 Application Fee will be charged to your credit or debit card. This non-refundable fee covers the cost of checking your driving record and processing your application.

Member Renewal:
At the end of each year of membership, a $35 Annual Fee will be charged to your credit or debit card, unless you notify Community Car in advance that you do not wish to renew.

Note:
Fees may vary based on promotion codes and membership plans.

If you have any questions, call our office at 608.204.0000.


* indicates a required field. The application will not be processed without this information.

New Applicant - Member Application Form

Sunday, April 20, 2014
Individual
Choose a Password

Please select a password to be used for online reservations.

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Personal Contact Information
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Emergency Contact Information
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Payment Information
Credit Card Information

Payment Method: Credit Card

Card Number:    *
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Check this box if your Credit Card Address is different from your Primary Address
Driver Record Information

A routine check of your driving record will be made with your application.

For more details on eligibility requirements, click here.

 *How many moving violations have you had in the past 3 years?
 *How many at fault accidents have you had in the past 3 years?
YesNo * Have you had any alcohol related violations in the past 7 years?
Current License

You must be at least 21 years of age and have had a driver's license for at least 3 years to qualify for membership.
Under 21 or have questions? Click here for more details on eligibility requirements.

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Choose Date  Blank for licenses without a date of issue.
Choose Date   *
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Have you had a license from another state or country in the past three years?
Promotions
Promotion:  
Referrals and Promotions
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Existing Membership
Do you have a key fob already? If so, please enter your Community Car Member ID.
Verification
By submitting this application,
  1. I am certifying that everything stated in this application is true to the best of my knowledge.
  2. I understand that CommunityCar is authorized to retain this information whether or not my application is approved.
  3. I understand that CommunityCar is authorized to check my driving record and insurance score.
  4. I understand that this application and all of the above consumer reports will be used to determine my acceptance for membership.
  5. I agree to pay a non-refundable application fee and the non-refundable annual membership fee.
  6. I agree to be bound by this application and understand that failure to disclose my violations or accidents will cause automatic rejection of this application.

I understand and accept
 
 

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