Master Rental Agreement - Enrolment Form and Profile

Master Rental Agreement - Enrolment Form and Profile
Complete this form or sign up at www.avis.com.au/preferred it’s fast and easy!
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REQUIRED INFORMATION
Please use block letters
Wizard Number (if applicable)
Title Surname First Name PERSONAL INFORMATION
Company Name (if applicable)
Mr.
Ms.
Mrs.
Miss
Other
Middle Initial
Avis Worldwide Discount Number (AWD)
(if applicable)
Company Address (if applicable)
Suburb
State
Postcode
Home Address
Suburb
State
Postcode
If PO Box given as a mailing address, full address is also required
Suburb State Postcode Preferred Mailing Address
Home
Company
Yes, send me Avis email specials Email Address
Email
By including your email address, you consent to receiving all notices under the Avis Preferred Service (including amendments to the Terms and Conditions applicable to the Service) by email.
Yes, send me electronic receipts
Daytime Phone (
)
Driver’s Licence Number Date of Birth
/
/
You must hold a current licence (not being a learner’s licence or provisional licence) and have been licensed to drive for at least 12 consecutive months. Note: if your overseas driver’s licence is not in
English, you must forward a copy of your International Driver’s Permit to Avis.
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ASSOCIATION MEMBER
NRMA/RACQ/RACV Seniors
Australian Medical Association Other Name of Association
Membership Number
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FREQUENT TRAVELLER PROGRAM
(Choose one only)
Please complete the membership number for the frequent traveller program you wish to be credited for qualifying Avis rentals. Please include alpha prefix.
Qantas Frequent Flyer
Executive Club (British Airways)
Air Points (Air New Zealand)
Other 5
Mileage Plus (United Airlines)
KrisFlyer (Singapore Airlines)
Membership Number
CHARGE CARD BILLING INFORMATION
The following amounts will be debited to your nominated charge card below: (1) all Avis rental charges and fees in relation to the Avis Preferred Service at the time of rental; and (2) all tolls and fees after they
are incurred or notified to RMS by a toll road operator (see Section 8 below).
Diners Club MasterCard Amex Visa Avis
Type of card: Primary Card Number Expiry Date
MTH
I
YR
Alternative Card Number Expiry Date
MTH
I
YR
Note: Cash, cheques, debit cards and vouchers cannot be used for this Service.
FOR AVIS APPROVED CHARGE ACCOUNT CUSTOMERS ONLY
If you do not already hold an Avis charge card and you wish to have: (1) your Avis rental charges and fees debited to the Company’s account with Avis above and
(2) Your tolls and fees debited to the Company’s account with RMS above (see Section 8 below), this section is to be signed by an authorised company signatory
only.
I HEREBY AUTHORISE THE ABOVE APPLICANT TO BE ISSUED WITH AN AVIS CHARGE CARD LINKED TO THE COMPANY ACCOUNT NO.: AV869
AND I AUTHORISE (1) ALL RENTAL CHARGES, FEES, COSTS AND AMOUNTS INCURRED BY THE APPLICANT (INCLUDING FOR THE OPTIONAL SERVICES/COVERAGES
‘ACCEPTED’ BELOW) TO BE DEBITED TO THAT ACCOUNT AND (2) ALL TOLLS AND FEES TO BE DEBITED TO THE COMPANY’S ACCOUNT WITH RMS (SEE SECTION 8 BELOW).
Name
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Authorised Signatory
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Position
OPTIONAL SERVICES/COVERAGES
Please read the applicable sections of the attached Avis Preferred Service Terms and Conditions booklet before completing this part of the Enrolment Form.
The information below is a guide only and is subject to those Terms and Conditions. Charges and options for services and coverages (in this
form, each a ‘service’) vary by country and are subject to change without notice. Please check the Avis website at: www.avis.com.au for all
current charges and terms and conditions applicable to a service at the time of rental.
• Loss/Collision Damage Waiver
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 amount is payable. May not be available from all Avis locations.
It is included in most rates in Australia. Known as:
• Motor vehicle Insurance (MVI) (in New Zealand) (compulsory for a renter not domiciled in NZ) • Collision Damage Waiver (CDW) (in Europe)
• Loss Damage Waiver (LDW) (in USA/Canada)
Please Initial
_______
Accept
_______
Decline
_______
Accept
_______
Decline
_______
Accept
_______
Decline
_______
Accept
_______
Decline
The following services are available at selected locations in Australia:
• Excess Reduction (ER)
In Australia, ER reduces your excess amount (see above section). Varies by age of renter, location, type of vehicle and rate. Note: ER does not
cover certain loss or damage.
• Protection Package
Includes: Excess Reduction (ER), Personal Accident Insurance (PAI), Personal Effects Insurance (PEB).
• Portable GPS
IMPORTANT NOTE: If you do not initial the ‘Accept’ or ‘Decline’ boxes for a service above, we will record ‘Decline’ in our records
for that service. You will, therefore, not have the benefit of such service and may be responsible for all loss or damage to a vehicle
depending on the terms and conditions of the Avis Rental Agreement in the country where the rental takes place.
Continue over
Master Rental Agreement - Enrolment Form and Profile (Page 2)
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car group preference
(Select One Only)
X - Economy - manual/air-con
F - Full Size Wagon - auto/air-con
A - Compact - manual/air-con
P - Full Size Sports - auto/air-con
B - Compact - auto/air-con
G - Premium - auto/air-con
C - Intermediate - auto/air-con
H - Luxury - auto/air-con
D - Standard - auto/air-con
V - Full Size Van - auto/air-con
E - Full Size - auto/air-con
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For full range of vehicles go to:
www.avis.com.au click on Cars and Services
Please nominate your preference.*
Smoking
Non Smoking
*Whilst every effort will be made to accommodate your preference, this cannot be guaranteed.
ACKNOWLEDGEMENT, AGREEMENTS, PRIVACY CONSENTS AND AUTHORISATION
By signing below:
1.you acknowledge that you have read and understood this form and the Avis Preferred Service Terms and Conditions attached to this form (Avis Preferred
Service Terms and Conditions);
2. you agree to be bound by the Avis Preferred Service Terms and Conditions as amended from time to time and as located on the Avis website, including:
(a) that you are liable for the loss of and all damage to the Vehicle unless this liability is reduced (see above);
(b) that, depending on the country of rental, you are always liable for the Excess Amount (and additional charges) and certain damage to the vehicle;
(c) (Australia only) ‘RMS E-Toll Facility Terms and Conditions for the Avis Preferred Service’ (including the obligation to pay to Roads and Maritime
Services ABN 76 236 371 088 (RMS) the RMS service fee when you use an Australian toll road in addition to payment of the applicable tolls) as set out in the Avis Preferred Service Terms and Conditions;
(d) the applicable Avis Group Privacy notices and policies;
(e) ‘RMS Privacy Consent and Agreement for the Avis Preferred Service’; and
(f) those services and coverages above which are included or which you have accepted by initialling,
each as set out in the Avis Preferred Service Terms and Conditions;
3.
you consent to Avis (as defined in the ‘Australian Terms and Conditions’ of the Avis Preferred Service Terms and Conditions) and RMS disclosing your information to entities located outside Australia for the purposes set out in the ‘Avis Australia Privacy Notice’ and ‘RMS Privacy Consent and Agreement for
the Avis Preferred Service’ respectively (each set out in the Avis Preferred Service Terms and Conditions), on the basis that neither Avis nor RMS is required to ensure that any overseas recipient complies with Australian privacy laws; and
4. you authorise:
(a) Avis to debit all rental charges, fees, costs and amounts; and
(b) RMS to debit all tolls and fees,
to your nominated charge card above.
Tick this box if you do not want Avis to use your information to send you details about products and services which are provided by Avis or any of its related companies, licensees and program partners.
Signature
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Date
Print Name
First Name
Send to: FREE POST
Avis Preferred Service
Reply Paid 204
MASCOT NSW 1460
or
Fax: 1800 129 731
Last Name
Any questions: Email: preferred@avis.com.au
Tel: 1800 553 787
P888800
Avis Australia, Level 2, 15 Bourke Road, Mascot, NSW 2020. Preferred Helpline 1800 553 787. Facsimile 1800 129 731.
W.T.H. Pty. Limited - ABN 15 000 165 855 - Avis Licensee. CT8959(C) 7/12