ABN 56 670 826 212
Rental Agreement
Renter
Driver’s Licence Number:
Expiry Date: ____/____/____
State / Country of issue:
Date of Birth: ____/____/____
Authorised Driver
Driver’s Licence Number:
Expiry Date: ____/____/____
Make State / Country of issue:
Date of Birth: ____/____/____
Vehicle
Odometer Reading
@ Check Out:
@ Check In:
Is the fuel tank full at Start of Rental?
[Yes] [No]
Rental Period
Start Date ___/____/____
Start Time am/pm
End Date ____/____/____
End Time am/pm
Damage Excess
Payable for Damage, Third Party Loss or theft of the Vehicle
Up to $ (plus GST)
Rental Charges
Excess kilometres (more than 700 kms per day)
@ $0.30 per km
$
Total Rental Charges (including GST)
$
Credit Card Details
Credit Card type
[__] Visa [__] MasterCard [__] Other: _________________
Name on the Card:
Expiry Date:
Credit Card Number:
CVV Code:
I have read the Rental Agreement and the Terms and Conditions and I agree:
(a) to pay the Rental Charges as shown in the Rental Agreement; and
(b) to be bound by the Terms and Conditions
Authorised Driver signature
Date
BY SIGNING THIS RENTAL AGREEMENT YOU ARE AGREEING TO THE HIRE TERMS AND CONDITIONS.
VEHICLES MUST BE RETURNED CLEAN AND FULL FUEL
BANK DEPOSITS
BANK NAME : ADAPTIVE RESOURCES WA
BSB : 062 692
ACC : 79720428
