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Thanks for your interest in Carpingo™ for Business. To ensure you can start adding drivers right away, please complete all required fields on this form. If you have any questions during this process, please call us at 888-604-4160 during regular business hours or email us at info@carpingo.com.

Reminder: 
Be sure to check that your company and drivers are eligible before taking the time to fill out the application.

Regards,
 Carpingo team

New Applicant - Member Application Form: Organizations

Wednesday, April 23, 2014
Organization
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Organization Contact Information
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Payment Information
Credit Card Information
  • You must have a credit card to be eligible for Carpingo 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.

Payment Method: Credit Card

Card Number:    *
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Check this box if your Credit Card Address is different from your Primary Address
Promotions
Promotion:  
Additional Information
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Verification
Applying to Carpingo is the first step toward becoming a member. You are not eligible to drive a Carpingo 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 Carpingo to retain this information for their use whether or not my application is approved.
  3. I authorize Carpingo to check my driving record to assist in determining my acceptance for membership. Carpingo 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 Carpingo's insurance and upon discovery of such information, Carpingo 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.

I understand and accept
 
 

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