FAX Payment to:

FAX NUMBER (within Australia): (02) 9361 6998
From International to Australia: +61 2 9361 6998

 Please PRINT this form on your own printer.
Then, complete it with the requested information and FAX it to us.

Your Details
Name
 :
Country of Residence
 :
Address
 :
Phone Number
 :
Fax Number
 :
E-mail
 :
Vehicle Details (if known)
Requested Vehicle
 :
Pick up date
 :
Pick up Location
 :
Drop off date
 :
Drop off Location
 :
Credit Card Details
Card Type
 :
Name (as on card)
 :
Card Number
 :
Expiry Date
 :
Signature
 :

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