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Elite Counter Insurance

Elite Counter Insurance Daily Supplemental Rental Insurance Portal Submission


Elite Counter Insurance
1333 E 9400 S Suite 105
Sandy, Utah 84093


T: (801) 730-6535


9am to 5pm Mon-Fri
(central time zone)

Daily Supplemental Rental Coverage Request

Rental Start Time(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
Customer Name(Required)
Renter's Contingent Liability Insurance
Supplemental Liability Insurance
Supplemental Physical Damage Warranty
Personal Effects Insurance
Accepted file types: jpg, png, pdf, jpeg, Max. file size: 3 MB.
Accepted file types: jpg, png, pdf, jpeg, Max. file size: 3 MB.
My Signature above acknowledges our Rental Operation's acceptance of the charges for the dates listed above for the coverages I have selected in accordance with my policy with Elite Counter Insurance. Upon submission, I understand that the policy will be in effect and no refunds or cancellations are permitted. I further understand there are no extensions permitted, renters must always execute a new rental agreement and sign a new supplemental car rental agreement for coverage to continue.

© 2024 Cocci Rentals LLC, DBA: Elite Counter Insurance