Amalie Car Rental Inc.
Reservation Form

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To place a reservation for your preferred vehicle and dates please complete the following form and submit it to us. We will provide you with a confirmation via e-mail.

Read our Collision Damage Waiver policy.

Please provide the following contact information:
* Denotes required field

CONTACT INFORMATION

First Name *

Middle Initial

Last Name *

Organization

Street Address *

Address (cont.)

City *

State/Province *

Zip/Postal Code *

Country

Work Phone

Home Phone *

FAX

E-mail *

Please provide the following ordering and billing information:

ORDERING INFORMATION

Type of car

Over 25 years old *

From Date MM/DD/YY

To Date MM/DD/YY

BILLING

Credit Card
*

Cardholder Name *

Card Number *

Expiration Date *

DRIVER'S LICENSE INFORMATION

Name of Driver *

DL# *

State *

Expiry MM/DD/YY*

Driver's Birthdate MM/DD/YY

OTHER INFORMATION

Name of Hotel or Villa where you will be staying *

If you require pick-up please provide the following:

PICK-UP INFORMATION

Airline

If Other Specify

Flight # if known

Time of Arrival

Date of Arrival

Number of People *

Should you have any other questions, comments or special requirements please note them here.

COMMENTS

	CONTACT INFORMATION
First Name	*
Middle Initial
Last Name	*
Organization
Street Address	*
Address (cont.)
City	*
State/Province	*
Zip/Postal Code	*
Country
Work Phone
Home Phone	*
FAX
E-mail	*

	ORDERING INFORMATION
Type of car
Over 25 years old	*
From Date	MM/DD/YY
To Date	MM/DD/YY

	BILLING
Credit Card	*
Cardholder Name	*
Card Number	*
Expiration Date	*

	DRIVER'S LICENSE INFORMATION
Name of Driver	*
DL#	*
State	*
Expiry	MM/DD/YY*
Driver's Birthdate	MM/DD/YY

	OTHER INFORMATION
Name of Hotel or Villa where you will be staying	*

	PICK-UP INFORMATION
Airline
If Other Specify
Flight #	if known
Time of Arrival
Date of Arrival
Number of People	*

Amalie Car Rental Inc. Reservation Form

Copyright © 2006 [Amalie Car Rental Inc.]. All rights reserved. Revised: February 03, 2006

Amalie Car Rental Inc.
Reservation Form

Copyright © 2006 [Amalie Car Rental Inc.]. All rights reserved.
Revised: February 03, 2006