Fillable Printable Passenger Waiver Form - Washington
Fillable Printable Passenger Waiver Form - Washington
Passenger Waiver Form - Washington
12240 Indian Creek Court
Beltsville, MD 20705
DC/MD (301) 2103500 VA (703) 6984400 Toll Free (800) DELIVER Fax (301) 4197075
PASSENGER WAIVER
Date: _______________________
I, ____________________________ have asked to ride as a passenger in the motor vehicle making a
freight delivery of materials on the behalf of my employer or myself. As a condition of being
permitted to ride, I hereby agree to the following:
1. I release Washington Express, LLC, its owners, employees and agents (the releasees) from any
and all liability related to the ride.
2. I agree to indemnify and hold the releasees harmless from and against any claims which I may
have as a result of the ride.
3. I assume all risk and liability while on the ride.
4. No duty shall be imposed on the releasees as a result of the ride.
The foregoing agreement is made on behalf of me, my heirs, successors and assigns.
______________________________________________
Passenger Signature
______________________________________________
Passenger Name
______________________________________________
Company Name
Tracking Number: _______________________________
