RESERVATION FORM
Name
Company Name
Date
Phone
Fax
Email
Driver Details
Full Name of Driver
Perth (Contact) Address
Perth (Contact) Phone Number
Permanent (Home) Address
Permanent (Home) Phone Number
Drivers License Details (Driver 1)
License Number
State/Country
Expiry Date
Date Of Birth
Drivers License Details (Driver 2)
Full Name
Home Address
Phone Number
License Number
State/Country
Expiry Date
Date Of Birth
Vehicle Requested
Type
Approx Number of Days
Rate($)Per Day
Collision damage waiver @ $16.00 per day. $19.00 per day on Group M & N trucks.
Commencement Date
Date
Time
AM
PM
Pickup From
Rental Office
Hotel
International Airport
Domestic Airport
Virgin
Qantas
Other
Flight Number
Return Date and Time
Date
Time
AM
PM
Return From
Rental Office
Hotel
International Airport
Domestic Airport
Virgin
Qantas
Other
Country Use Declaration
Yes
No
If yes, please provide more information (eq. country destination)
Flight Number
Departure Time
AM
PM
Payment Type
Visa
Bank Card
Mastercard
Amex
Diners
Card Number
Card Holder Name
Expiry Date
Anticipated Destination
Child Seats Available
Baby Capsule
Child Seat
Booster Seat
Prepaid fuel
Yes
No
Additional Requests
How did you come to hear about us?
Yellow Pages
Friend Referral
Previous Customer
Accommodation Package, if so,which one?
Internet, if so,which search engine or website?
For more information, please
Contact us
