This form MUST be filled out and e-signed by the credit card holder 25yrs or older. The card holder on this agreement MUST be present with their credit card and drivers license upon pickup of the machine(s).
(*) Required information
*First and Last Name:
Cell Phone:
*Home Phone:
*Email:
*Billing Address: Make sure this matches the address on file with your credit card company to avoid any issues.
*Billing City:
*Billing State: Select... AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Leave blank for outside US
*Billing Zip/Postal code:
Country:
*Driverse License #:
*State Issued:
*Credit Card #: Please double check for typo's
*CC Experation Month/Year: Select...010203040506070809101112/ Select...202220232024202520262027202820292030
*CC Cvv Code:
A 4% convenience fee will be charged in addition to the tax for using a credit card for the rental. To avoid the additional 4% fee, check the paying cash box. The security deposit must still be put on a credit card.
Paying Cash
*Starting Date: (Month/Day/Year)
*Ending Date: (Month/Day/Year)
Rentals Times:
Full-day 9AM-4PM Only offered September - April Half-Day Select...9am-12pm1pm-4pm Afternoon half day option is not available until October 1st
*Select Rental Machine(s): (Price does not include 9.2% tax and 4% convenience fee) (Does include Gas 1 tank of gas) Half-day is $100 off the Daily Price
2-seat Kawasaki KRX 1000 $400/day
2-seat Can-Am Commander 1000 $400/day
4-seat Kawasaki KRX 1000 $500/day 4-seat Kawasaki KRX 1000 $500/day 4-seat Kawasaki KRX 1000 $500/day
4-seat Can Am Commander 1000 $500/day
Any special notes/request type them here:
Within a few hours after submitting this form within normal business hours 9am-4pm a rental agreement will be sent to the email listed above to e-sign. If you do not see the email make sure you check your spam/junk mail. The email should be coming from amy@rentalphoenixaz.com
Please confirm all the above information is correct especially the billing address, if the billing address is not correct you may see 2 charges for the security deposit.
By signing this form I agree to be charged for the above selected date, time, and machine(s) to be rented.