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: Please double check it matches what's on file with your credit card company
*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:
*Select Rental Machine(s):
2-seat Polaris RZR XP1000 $350/day
2-seat Kawasaki Teryx KRX 1000 $400/day
2-seat Can Am Maverick X3 Turbo $450/day
4-seat Polaris RZR XP1000 $400/day
4-seat Polaris RZR XPTurbo $450/day
Polaris Ranger Crew 900 $400/day
*Starting Date: (Month/Day/Year)
*Ending Date: (Month/Day/Year)
*Select Rental Time:
Full Day 9am-5pm
Half Day 8am-12pm No half days offered Friday-Sunday
Half Day 1pm-5pm No half days offered Friday-Sunday
Guided Tour 3-4hrs Tours are not offered Saturday's or Sunday's and must have at least 2 machines.
Guided Tour Time: Select...9am-12pm1pm-4pm Tours are not offered Saturday's or Sunday's and must have at least 2 machines .
Any special notes/request type them here:
*Credit Card #: Please double check for typo's
*CC Experation Month/Year: Select...010203040506070809101112/ Select...20172018201920202021202220232024202520262027
*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
Within an hour or two after submitting this form within normal business hours 9am-5pm 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.