DRIVER'S / RENTER'S INFORMATION
Full Name:
required
Home Address:
City / Zip Code:
State / Country:
Telephone No.:
Please include country + area codes
Fax No.:
Please include country + area codes
Email Address :
required
Driving License No:
Date of issue:
(dd/mm/yy)
Date of expire:
(dd/mm/yy)
Country of issue:
CAR RENTAL INFORMATION
Desired Model:
Daewoo Matiz
Daewoo Matiz a/c
Hyundai Atos A/C
Fiat Seicento open top
Fiat Punto a/c
Hyundai Accent A/C
Suzuki Samurai 4X4
Suzuki Jimny 4X4
First Day of Rental:
January
February
March
April
May
June
July
August
September
October
November
December
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2010
2011
Delivery Time:
Last Day of Rental:
January
February
March
April
May
June
July
August
September
October
November
December
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2010
2011
Collection Time:
Delivery Location:
Collection Location:
Total Price of Rental:
Method of payment:
Credit Card
(please download, print, fill in and send us the authorization form by fax)
Bank Deposit
(please transfer a 20% deposit to our bank account and send us a photocopy of the transaction by fax)
Comments and Additional Information:
.
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