Passenger Authorization and Releases of Liability

(Both Passenger and Driver Should Read Carefully Before Electing to Voluntarily Sign)

In accordance with 49 C.F.R. 392.60, authorization is granted to the Driver (identified below) to have
the Passenger (identified below) on the specified truck. Passenger is not authorized and is
specifically prohibited from operating the truck or associated trailer or performing any labor or duties
associated with the equipment or load at any time for any reason, including communicating with
operations or office personnel. DriveLink Services LLC, may request and review video to ascertain that
only the driver named below is operating the truck. Passenger is prohibited from entering any loading
or unloading or vehicle maintenance area. Passenger shall be solely responsible for transportation
home or otherwise at any time, regardless of reason, location, circumstance, or cost.

Trip Origin: Springdale, AR
Destination: All points in the United States

Driver Name Driver Name First Last
Unit Number
This document constitutes authority by DriveLink Services, LLC for ("Passenger") to be transported as the only passenger.

THIS AUTHORIZATION MUST BE CARRIED, AT ALL TIMES WHILE IN EFFECT, ON
THE TRUCK BY THE DRIVER TO WHOM IT IS ISSUED

Expires at the end of each year and must be renewed no late that January 1 of the new year.
Passenger Name Passenger Name First Last
Passenger Date of Birth Passenger Date of Birth / MM / DD YYYY
Passenger Drivers License # or Stated Issued ID # and State of Issue
Trip Start Date Trip Start Date / MM / DD YYYY
Trip End Date Trip End Date / MM / DD YYYY

New passenger authorization form required each year and or for each passenger.
Passenger is not authorized and is specifically prohibited from operating the unit or associated trailer (collectively "Equipment") or performing any labor or duties associated with the Equipment or load at any time for any reason. Passenger is prohibited from entering any loading or unloading or vehicle maintenance area. Passenger shall be solely responsible for transportation home or otherwise after Destination Date is reached regardless of reason, location, circumstance or cost. - Initial Below

Passenger Initials
Passenger’s Voluntary Assumption of Great Risk

Passenger or guardian hereby specifically acknowledges that serious personal injuries and deaths frequently occur to Passengers from motor vehicle accidents as well as from getting in or out of commercial vehicles.
Passenger or guardian hereby specifically acknowledges that serious personal injuries and deaths frequently occur to Passengers from motor vehicle accidents as well as from getting in or out of commercial vehicles. “By my initials below I acknowledge I am voluntarily exposing myself or my minor dependent to these and other similar risks in exchange for authority to ride as a passenger in DLS owned or leased Equipment”. I hereby certify I will use a seat belt anytime the vehicle is in motion. - Initial Below

Passenger Initials
Release Of Liability

By signing below, Driver and Passenger (and/or Passenger's parent or legal guardian)) hereby
release and hold harmless DriveLink Services, LLC and its insurers, officers, directors, agent and
employees and any subsidiary corporations from any and all claims, damages, lawsuits, liability for
personal injury, including rights under any claim for loss of affection or loss of consortium, death, and
loss of or damage to property in any way during the authorized trip, whether known or unknown,
which Driver of Passenger may now have or later have. Passenger further specifically acknowledges
that serious personal injuries and deaths frequently occur to passengers from motor vehicle accidents
as well as from getting in and out of commercial vehicles. Passenger acknowledges that he or she is
voluntarily exposing himself or herself to these and other similar risks in exchange for authority to
ride as a passenger. Passenger agrees to use a seatbelt at any time the specific truck is in motion.
Driver Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Signed Date Signed / MM / DD YYYY
Passenger Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Signed Date Signed / MM / DD YYYY
Upload an Image of Passenger Drivers License or Photo ID.

Passenger Authorization and Releases of Liability

Passenger Authorization and Releases of Liability

Passenger’s Voluntary Assumption of Great Risk

Release Of Liability