|
1. Booking Information
|
|
Please supply all details requested in sections 1-3 to allow us
to process your booking.
|
|
|
You will need a confirmation code from us before you
can complete this booking form
|
|
|
Confirmation Code:
|
*
|
|
|
Title:
|
|
|
|
Full name:
|
*
|
|
|
Occupation:
|
|
|
|
Motorhome type:
|
|
|
|
Hire - From:
|
* DD/MM/YYYY
|
|
|
Hire - To:
|
*
DD/MM/YYYY
|
|
|
2. Contact Details
|
|
|
|
|
|
|
Address:
|
|
|
|
County/State:
|
|
|
|
Postcode/Zip code:
|
|
|
|
Country:
|
|
|
|
Phone (home):
|
|
|
|
Phone (work):
|
|
|
|
Mobile phone:
|
|
|
|
Email:
|
*
|
|
|
3. Main Driver Details
|
|
|
|
|
|
|
Drivers with overseas licence please add £4 per day as per insurers
terms of hire.
Drivers with motoring offences please add £4 per day per offence
as per insurers terms of hire.
|
|
|
|
|
|
|
Title:
|
|
|
|
Full name:
|
*
|
|
|
Address:
|
|
|
|
County/State:
|
|
|
|
Postcode/Zip code:
|
|
|
|
Country:
|
|
|
|
Date of birth:
|
* DD/MM/YYYY
|
|
|
Occupation:
|
*
|
|
|
Mobile phone:
|
|
|
|
Licence No:
|
*
|
|
|
Date passed:
|
* DD/MM/YYYY
|
|
|
Country licence issued from:
|
*
|
|
|
|
Any accidents in the past 3 years?
|
|
|
Any physical or mental defects or infirmity?
|
|
|
Have you been convicted of any motoring offence in the last 3 years?
|
|
|
Have you ever been refused insurance?
|
|
|
Number of endorsements in last 5 years:
|
|
|
|
|
|
|
|
|
|
|
|
Please be aware it may prohibit you from driving, i.e. cover on insurance,
if you fail to disclose any motoring endorsements and any pre-existing
medical conditions.
|
|
|
|
4. First Additional Driver
|
|
Only fill out the details below if a additional driver is required.
|
|
|
|
|
|
Please note additional driver is £4 per day as per insurers terms
of hire.
|
|
|
|
|
|
|
Title:
|
|
|
|
Full name:
|
|
|
|
Address:
|
|
|
|
County/State:
|
|
|
|
Postcode/Zip code:
|
|
|
|
Country:
|
|
|
|
Date of birth:
|
DD/MM/YYYY
|
|
|
Occupation:
|
|
|
|
Licence No:
|
|
|
|
Date passed:
|
DD/MM/YYYY
|
|
|
Country licence issued from:
|
|
|
|
| Any accidents in the past 3 years? |
|
| Any physical or mental defects or infirmity? |
|
| Have you been convicted of any motoring offence in the last 3 years? |
|
| Have you ever been refused insurance? |
|
| Number of endorsements in last 5 years: |
|
|
|
|
|
|
|
|
|
|
| Please be aware it may prohibit you from driving, i.e. cover on insurance, if you fail to disclose any motoring endorsements and any pre-existing medical conditions. |
|
|
|
5. Extra Details
|
|
|
|
|
|
|
No in party:
|
Adults Children
|
|
|
If travelling with children you MUST supply the appropriate booster
/ child seats. Please refer to the motorhome specifications for the number of available belted seats.
|
|
|
|
|
|
|
Destination:
|
*
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Please ask about our East Midlands Airport Service
|
|
|
|
|
|
Additional Information - Please use the box below to inform us of any
extra details:
|
|
|
|
|
|
|
6. Extras
|
|
|
|
|
|
|
|
|
|
|
*
I have read, understood and agreed to your terms
and conditions
|
|
|
|
|
|
Boxes marked * must be completed
Your privacy is very important to us! All information provided
are solely used for reservation purposes only. We do not submit any
information to third parties.
We will be in touch regarding your payment of the 20% deposit, once
we have processed your reservation.
|
