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Application to sign up for a Personal account

Thanks for your interest in membership with Capital CarShare. Please complete all required fields on this form. Be sure to check that you are eligible before taking the time to fill out the application.

A non-refundable application fee of $20.00 will be charged to your credit card to cover the processing costs of your application. If you do not agree to this application fee, do not submit this form.

If you have any questions during this process, please call us during normal business hours at 716-898-0850 or email us at info@capitalcarshare.org.


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

New Applicant - Member Application Form

Monday, August 31, 2015
Individual
Choose a Password & PIN

Please select a password to be used for online reservations, and a PIN for telephone reservations.

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Personal Contact Information
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Emergency Contact Information
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Payment Information
Credit Card Information
  • You must have a credit card to be eligible for a CarShare membership. An authorization (not a charge) of $1.00 will be attempted on the credit card you submit below simply to verify that it is valid.
  • The non-refundable application fee, as stated in the box above will be charged to your credit card to cover the processing costs of your application. If you do not agree to this application fee, do not submit this form.

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 to process your application. For the past three years, indicate the number of incidents you have had:
  • Moving violations (speeding, other traffic tickets)?
  • Reported accidents where you were fully or partially at fault?
  • Driving while under an influence (DUI) convictions?
 *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
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Choose Date  
Choose Date   *
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Check this box if within the past 3 years you had a driver's license issued by a state different than the state issuing your Current License
Referrals and Promotions
Promotional Code?
How did you find us? *
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Other? Please tell us how
Has anyone referred you?
Which college or university are you affiliated with? *
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Verification
Applying to Capital CarShare is the first step toward becoming a member. You are not eligible to drive a Capital CarShare vehicle until you have been approved.

By submitting this application,
  1. I certify that everything stated in this application is true to the best of my knowledge.
  2. I authorize Capital CarShare to retain this information for their use whether or not my application is approved.
  3. I authorize Capital CarShare to check my driving record to assist in determining my acceptance for membership. Capital CarShare may review my driving records without notice at any time to determine my ongoing eligibility to be a member.
  4. I certify that I am at least 21 years of age OR that I am 18-20 years old and agree to provide insurance coverage for the duration of my membership, while I am under 21 years of age. I understand that if I have misrepresented my age, I will be immediately disqualified from use of Capital CarShare's insurance and upon discovery of such information, Capital CarShare will terminate my membership.
  5. 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.
  6. I agree, and therefore electronically sign by clicking submit, Capital CarShare's Membership Agreement stated here:  http://buffalocarshare.org/agreement.pdf

I understand and accept
 
 

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