Booking Request Form: Vantastic Wheelchair Accessible Car Rental
Main Rental Information
Rental Start Date *
MM
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DD
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YYYY
Rental End Date *
MM
/
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
Wheelchair Passenger: Full Name *
Your answer
Wheelchair Passenger: Address *
Your answer
Wheelchair Passenger: Date of Birth *
MM
/
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 *
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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