Booking Request Form: Vantastic Wheelchair Accessible Car Rental
Main Rental Information
Rental Start Date
MM
/
DD
/
YYYY
Rental End Date
MM
/
DD
/
YYYY
Main rental contact Name
Your answer
Main rental contact Number (mobile No)
Your answer
Main rental contact E-mail
Your answer
Wheelchair Passenger Details
Please complete the Wheelchair Passenger details below
Wheelchair Passenger: Full Name
Your answer
Wheelchair Passenger: Address
Your answer
Wheelchair Passenger: Date of Birth
MM
/
DD
/
YYYY
Wheelchair Passenger: Gender
Nominated Drivers
Please list Nominated drivers below. Please note all Nominated drivers must complete the online "Nominated Driver Registration Form"
Main Nominated Drive: Full Name
Your answer
Optional - Second Nominated Driver: Full Name
Your answer
Optional - Third Nominated Driver: Full Name
Your answer
Optional - Fourth Nominated Driver: Full Name
Your answer
Please list any other optional additional drivers in this section
Your answer
Promotion Code
please input promotion code here if relevant
Your answer
I have read and agree to the Vantatsic Rental Terms and Conditions
as per Rental Cars - Terms and Conditions on Vantastic.ie
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