BOOKING FORM + CONTACT

RESERVATION FORM

EUROLEASE

Citroen Peugeot Renault

_________________________________________________________________________________________________

3/2 Paton Place, Balgowlah NSW 2093 Sydney Australia

Phone: 02 9949 1595 Fax: 02 9948 2901

Booking No _________ (office use only)

We only accept Visa & Mastercard


Personal Details	o Past Client
Title: First Name:	Surname:
Nationality:(as shown on passport)	Occupation :
Address
No.Street
City:	State: Postcode:
Contact Details
Phone(h)	Phone
Phone(m)	Fax:
Email:

Passport Details (as shown on passport)	o
Date of Birth:	Passport Number:
Birth Town:	Date of Issue:
Birth Country:	Location of Issue :

Vehicle Model	Vehicle Code

Transmission: Manual/automatic	(Please circle) Diesel/petrol Sedan / Wagon
No of Days:	Date ex Australia:
Pick up date:	Pick up Location:
Flight Number:	Flight Arrival Time:
Return date:	Return Location:
Flight Number:	Flight Departure Time:
Accessories


Payment Details (for deposit of $250)
---------- / --------- / --------- / --------- exp ------/------	Name on visa ___________________ Signature ______________________