CREDIT CARD SECURE BOOKING FORM
Australia 4 Wheel Drive Rentals
Australian Business Number 54 561 356 425
Australia 4 Wheel Drive Rentals Group of websites
GPO Box 3410 Darwin, Northern Territory Australia 0801
Tel International +61 8 7999 7511 In Australia 08 7999 7511
Fax International +61 8 7999 7510 In Australia 08 7999 7510


Instructions:

  1. This is a secure web page. Any information that is sent using this form is encrypted.
  2. You also have the option of making a booking by fax. To do this print, fill out and sign this web page and fax to Australian Head Office Reservations - In Australia 08 89455507 - International +61 8 89455507
  3. IMPORTANT: Please take note that FULL DETAILS are required in order to successfully complete a booking

 

Client Information
Title
First Name
(Christian name)
 (required)   
Last Name
(Family or surname)
 (required)   
Street Address  (required)   
City / Suburb  (required)   
State / Province  (required)   
ZIP / Postcode  (required)   
Country  (required)   
Mobile  (country)  (area)
Phone  (country)  (area)
Fax  (country)  (area)
Email  (required)     
Vehicle Information
Type of vehicle
No. of vehicles
Comments
(If you cannot easily find your vehicle please refer to your quote and type in the comment box the vehicle to be booked)
Quote reference no.
Flight Arrival Details
(car only)
Time
Flight No.
Pick-up Information
Pick-up Location  (required)    
 (if other please specify)
Pick-up Date
Drop-off Information
Drop-off Location  (required)
 (if other please specify)
Drop-off Date

No. of people travelling
(the total number of adults and children must not exceed the capacity of the vehicle you have selected)

 (adults)    (children)
No. of drivers
Age of each driver  (required)   

Age of each child travelling
(some vehicles have restrictions for children under the age of 5. Please refer to vehicle restrictions on our website. If you are unsure please email us)

Insurance & Optional Extras
(Please note that insurance rates vary with the type of vehicle selected)

Please select one of the following insurance plans  (Agree to pay at pick-up full security deposit or bond)
 
 
Tables  (this may be an optional extra - please refer to our quote)
Chairs  (this may be an optional extra - please refer to our quote)
Awnings  (this may be an optional extra - please refer to our quote)
Booster Seats  (this may be an optional extra - please refer to our quote)
Baby Seats  (this may be an optional extra - please refer to our quote)

Payment Details
Payment arrangement
(Suppliers may require a deposit or full payment - please refer to your
quote for details)



 

Amount to be paid ($AUD)  (required)   
Purchase date      
Type of card
Credit card number  (required)   
Expiry date  (month)   (year)      
Security code
(last 3 numbers on back of credit card - VISA and MasterCard only)
 (required)   
Name on credit card  (required)   
Please note your credit card statement will show billing as " Australia 4 Wheel Drive Rentals"
Fax Bookings Only:




..............................................
Signature of credit card holder
Additional information:

Please enter any additional information you wish us to know about:

Terms & Conditions of Booking

  1. By completing and submitting this form I hereby acknowledge that I agree to a booking.
  2. I agree to abide by the terms and conditions of this booking.
  3. I agree to a deposit or full payment, as quoted, being taken from the credit card specified above.
  4. I have read, understood and agreed to the cancellation policy, terms and agreement of Australia 4 Wheel Drive Rentals and their suppliers. Click here to view our Terms and Agreement

This booking cannot proceed until you agree to the terms and conditions specified above.