SELAH Mobility

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Selah Mobility Driver Application

Weekly vehicle rentals for approved gig drivers. Built for Uber, DoorDash, Instacart, and more.

SECTION 1: PERSONAL INFORMATION

Full Name *

Phone *

Email *

Date of birth *

Driver’s License Number *

State Issued *

Select an option

License Expiration Date *

SECTION 2: ADDRESS

Street Address

City

State

Country

Enter your country

Postal Code

How long have you lived here?

SECTION 3: DRIVING/WORK INFORMATION

Which platforms do you plan to use?

DoorDash

Uber Eats

Instacart

Amazon Flex

Uber/Lyft

Other

Do you currently have active accounts?

Select an option

SECTION 4: AVAILABILITY & PAYMENT

How soon do you need a vehicle?

Immediately

Within 1 week

Just exploring

Are you able to pay $_ per week?

Yes

No

Do you have $_ available today (deposit)?

Yes

No

Preferred payment method

Cash

Cash App

Zelle

Apple Pay

Other

SECTION 5: DRIVING HISTORY

Any accidents in the past 3 years?

Yes

No

If Yes (Explain):

Any DUIs or major violations?

Yes

No

SECTION 6: RESPONSIBILITY AGREEMENT

Responsibility Agreement *

I will maintain the vehicle responsibly

I will not allow unauthorized drivers

I am responsible for gas

I will return the vehicle in good condition

Late payments may result in repossession

SECTION 7: DOCUMENT UPLOAD

Driver's License *

Click to upload

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Selfie with license *

Click to upload

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Proof of insurance *

Click to upload

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

SECTION 8: FINAL CONFIRMATION

I certify the information provided is accurate

Signature *

Clear

Copyrights 2026 | SELAH Mobility™ | [email protected] | Serving Jacksonville, FL