Preferred Service - Avis Car Rental | Avis Rent a Car
[pic] | |Master Rental Agreement - Enrolment Profile | |
| | |Return Fax: 1800 129 731 |
|Required Information |(Please use block letters) |
|Wizard | | |Title: Mr | |Mrs | |
|Number (if | | | | | | |
|applicable):| | | | | | |
| | | | | | | |
| | | | | | | |
|Wizard | | | | | | |
|Number (if | | | | | | |
|applicable):| | | | | | |
|Personal Information | |
|Company Name (If applicable): |SUN MICROSYSTEMS |AWD Avis Worldwide Discount Number (if applicable) |P815900 |
|Company Address | |Suburb | |State | |Postcode | |
|Home Address | |Suburb | |State | |Postcode | |
|Preferred mailing address: |Home | |Company | |If PO Box given as mailing address, full address is also | |
| | | | | |required. | |
|Daytime Phone |( ) |Driver’s Licence Number (letters and numbers) | |Date of Birth | / / |
|Tick here if you would like to receive Avis Email Specials | |Email Address | |
|Frequent Traveler Program |(Choose one only) |
| |Qantas Frequent Flyer | |KrisFlyer (Singapore Airlines) | |Executive Club (British Airways) | |Other (refer to .au for full |
| | | | | | | |listing) |
| |Air Points (Air New Zealand) | |Mileage Plus (United Airlines) | |Membership Number | |
|Charge Card Billing Information | |
|My preferred charge card is: | |Diners Club | |
|Alternative Card Number: | |Expiry Date: (MM/YY) | |
|Note: Cash, cheques and vouchers cannot be used for this service. Bankcard can only be used for Australian and New Zealand rentals. |
|If you do not already hold an Avis Charge Card and you wish to have your rentals charged to a company account, please ensure this section is signed by a person of |
|Authority other than the hirer |
|I HEREBY AUTHORISE THIS APPLICANT TO BE ISSUED WITH AN AVIS CHARGE CARD LINKED TO ACCOUNT NO.: AV869 |
|Name: | |Signature |X |Position | |
|Optional Insurance/Coverages | |
|*Loss/Collision Damage Waiver |Please Initial |
|Limits your financial responsibility for loss or damage to the Avis vehicle and in some countries third party property damage or injury (if you | | |
|comply with the Avis Rental Agreement). In some cases an excess applies. May not be available from all Avis locations and included in most rates| |X |
|in Australia. | | |
|Motor vehicle Insurance (MVI) (New Zealand) compulsory for renters not domiciled in NZ, Collision Damage Insurance (CDI) (United Kingdom), |Accept |Decline |
|Collision Damage Waiver (CDW) (Europe), Loss Damage Waiver (LDW) (USA/Canada) | | |
|*Excess Reduction (ER) (Available at selected locations in Australia) | | |
|In Australia reduces your excess in most cases from $2750 to $385. Varies by age of renter, location, type of vehicle and rate. Note: ER does | |X |
|not cover certain loss or damage. Charge per day: $20.00 on groups A - V. | | |
| |Accept |Decline |
| | | |
|*Protection Package (Available at selected locations in Australia) | |X |
|Includes: Excess Reduction (ER), Personal Accident Insurance, Personal Effects and Baggage Insurance (PEB). Charge per day: $24.00 on groups A | | |
|-V. Note: If you choose the Protection Package please read the PAI and PEB Policy and the Product Disclosure Statement (PDS) contained in the |Accept |Decline |
|Avis Preferred Service Program Terms and Conditions. | | |
| |
|*The above information is a guide only and is subject to the terms and conditions of the Avis Master Rental Agreement. Charges and options for insurance/coverage |
|vary by country and are subject to change without notice. Please check at the time of rental. For company applications, it is important to check with your company|
|regarding the options they have accepted as all charges will be charged to your nominated card. |
|IMPORTANT NOTE: If you do not initial the ‘Accept’ or ‘Decline’ boxes for insurances / coverage, we will indicate decline in our records for each such |
|insurances/coverage not initialled. You will, therefore, not have the benefit of such insurance/coverage and you may be responsible for all loss or damage depending|
|on the terms and conditions of the Avis rental Agreement in the country where the rental takes place. |
|Car Group Preference |(Select one only) |
| |X - Economy – manual/air conditioned, eg Hyundai Getz (3 door) | |G - Premium-auto/air conditioned, eg Holden Calais |
| |A - Economy – manual/air conditioned, eg Hyundai Accent (5 door) | |H - Luxury-auto/air conditioned, eg Holden Statesman |
|X |B - Compact-auto/air conditioned, eg Toyota Corolla Ascent (5 door) | |V - Luxury Van-auto/air conditioned, eg Toyota Tarago Wagon |
| |C - Intermediate-auto/air conditioned, eg Toyota Corolla Sedan | | |
| |D - Standard-auto/air conditioned, eg Toyota Camry Altise |Smoking and Non Smoking vehicles are now available |
| |E - Full Size-auto/air conditioned, eg Holden Commodore Executive |Please nominate your preference.* | |Smoking | |Non Smoking |
| |F - Full Size Wagon-auto/air con, eg Holden Commodore Station Wagon |*Whilst every effort will be made to accommodate your choice, this cannot be |
| | |guaranteed |
|Authorisation |(Select one only) |
|I authorise Avis to charge all costs relating to the Avis Preferred Service to the card account(s) nominated by me. I confirm that the above information is correct |
|at the date referred to below. I have read and understood and agree to the enclosed Avis Preferred Service Program Terms and Conditions ("Terms & Conditions") and |
|Avis Australia Privacy Policy relating to participation in the Service and rentals under the Program. I have read, understood and confirm each of the |
|acknowledgments that are set out in the Terms and Conditions booklet |
|Signature |X |Date | |
|PRIVACY: By completing this form you consent to us using and disclosing information about you for the purpose of your rental activity with Avis and other compatible|
|purposes including Avis’ business management, development and protection. You also consent to Avis disclosing your information to entities located outside Australia|
|for these purposes and acknowledge that you understand that once your information is held outside Australia it may not receive the same level of protection that |
|Australia’s Commonwealth Privacy Act requires. Avis may also use and disclose your information to send you information about products and services provided by Avis,|
|its related companies, franchisees and partner organisations. |
| |Tick this box if you do not wish to receive information about these products and services. |
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