Customer Registration Form:
Hire Vehicle Details:
Hire Vehicle on Policy: (or third party claim)
YESNO
Standard Excess Option $2,750.00
Private Hire Daily Rate Applies $25.00 per day Would you like to pay $1,000.00 Excess Reduction for $50.00 fee?
Drivers Licence:
Please upload a copy of your Drivers Licence front & back.
Signature
By signing below you agree to our standard Terms & Conditions set out on our website.
Thank you for your hire car order!
Please choose from the payment options below to pay for your insurance excess reduction to $1,000 should you need to make an insurance claim.
CHOOSE FROM BELOW TO PAY $50.00:
Pay with PayPalPay with Stripe
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