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SSL Certificate Authority
Unity Car Rental Confirmation Request Form

In order to make a Confirmation, please complete this form as fully as possible.
There is no cancellation fee if the vehicle is canceled at least one week
before the arrival date. If not, a $50 fee will be charged.

We use an encrypted secure server, but if you do not wish to provide this information online,
please complete the form below, print it out, and fax it to us at 011 590 87 44 09.


Fields labeled with * must be filled in


RENTER INFORMATION
Name *
Email Address *
Postal Address*
Home phone*
Work phone*



DRIVER'S LICENSE INFORMATION
Driver's License Number*
Issuing country/state*
Expiration Date*
Driver's Birthdate*



RENTAL CAR INFORMATION
Type of car*
Rental period from:*
to:*         
Collision Insurance* YES, I accept the collision insurance as in the price list
NO, I decline the collision insurance

Liability Insurance* YES, I accept the liability insurance as in the price list
NO, I decline the liability insurance


CREDIT CARD INFORMATION
Type of credit card
Card Number
(no spaces, please)
Expiration date
MM/YY

There is no cancellation fee if the vehicle is cancelled at
least one week before the arrival date. If not, a $50 fee will be charged.

Your card will not be charged until your arrival,
so you may change to a different card when the car is picked up.


COMMENTS
Comments
Arrival information
Best time to call, etc