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

Application Type Driver
Account Number *

Personal Contact Information

* indicates a required field.


First name *
Last Name *
Numbrer / Address *
Apt. / Office
City *
Province
State(US) / Country
Postal Code *
Email
Home Phone *
Work Phone
Cell Phone
Date of Birth *
Gender *

Emergency Contact Information

First name *
Last Name *
Telephone Number *
Relation to you

Driver Record Information - Current License

License Number *
Issued By
State(US) / Country
Date Issued
Expiration Date *
Years Driving

Upload a photocopy or photo of your driver's license (front + back)

Click or drag here only to add your file


Check this box if within the past 2 years you had a driver's license issued by a province different than the province issuing your Current License

Driver Record Information Review

Part 1: pre-screening your driving record

Are you at least 19 years old? *
Yes No

Do you have a NS Class 5 License or its equivalent? *
Yes No

Have you held a drivers license for at least the past 2 years? *
Yes No

In the last three years did you have more than 4 minor infractions or more than 6 points on your record? *
Yes No

In the past three years did you have any speeding violations 40 km per hour or more above the posted limits? *
Yes No

In the past five (5) years did you have more than one at-fault accident? *
Yes No

Do you have any DUI or other criminal motor vehicle offenses on your record? *
Yes No

We must verify your answers for insurance purposes. If you are from Atlantic Canada we can access your drivers record for you. This can take a few business days.

Licensed in any other province, state or country? Click here for how YOU can get a copy of your record. Your Application will be "on hold" until we have your record.

Verification

By submitting your application for a Carshare Atlantic Added Driver Member , you

  1. Certify that everything stated in this application is true to the best of your knowledge.
  2. Authorize Carshare Atlantic, its agents, and insurers to review your driving record and other background information as it shall deem relevant to its approval of your participation in the Carshare Atlantic program.
  3. Understand that this application and all of the above consumer reports will be used to determine your acceptance for membership.
  4. Understand that Carshare Atlantic and its agents and insurers will retain the information provided by you and the review of your driving record, whether your application is approved or not.
  5. Agree to be bound by this application and understand that failure to disclose any violations or accidents will cause automatic rejection of this application or later revocation of your membership.
  6. Acknowledge that you have reviewed the Carshare Atlantic Driver's Agreement and agree to observe and be bound by the terms, including any amendments to the document.
  7. Acknowledge that as an Added Driver your usage and other charges will be the responsibility of the Member to which you are joined, and that the Membership may impose conditions on your use separate from those set out in the Carshare Atlantic Driver's Agreement; and that the Membership has authority to restrict or remove you from its Drivers List and from use on its account of the Carshare Atlantic fleet.
  8. Acknowledge that Carshare Atlantic is not party to any agreement or disagreement between you and the Member.

I understand and accept (please check) *