Booking Request Form: Vantastic Wheelchair Accessible Car Rental
Returning Customer *
Main Rental Information
Rental Start Date *
MM
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DD
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YYYY
Rental End Date *
MM
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DD
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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
*
Your answer
Wheelchair Passenger: Address *
Your answer
Wheelchair Passenger: Date of Birth *
MM
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DD
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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
Second Nominated Driver: Full Name
Your answer
Confirmation of Rental Terms & Conditions
I confirm that I have read and agree to the Vantatsic Rental Terms and Conditions *
Confirmation of Vantastic Privacy Statement
I confirm that I have read and agree to the Vantatsic Privacy Statement *
Discount Code (If you have a discount code please enter it below)
Your answer
Sign Off
By typing your name below, you are electronically certifying this Booking Form just as if you would physically sign it if it was on paper.
Full Name *
Your answer
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