deposit form

All rentals, both car and van, must be prepaid at time of rental.

Billing Information
 
First Name:  Last Name: 
Home Address:  Address (cont.): 
City:  State: 
Zip:  Country: 
Phone:  Email: 
   

Driver's License & Insurance Information
   
Driver's License: Drivers License State:
 
Driver's License Exp:
Date
 
Insured By: Policy Number:
   
   

Payment Information

   
Name on Card:  Credit Card #: 
Credit Card: Expiration Date:  
Date
 
CVV2 # : 

What is CVV2?
   
How did you hear about us?
   
 
Comments: 
 

Rental Information
 
Rental Period:  
 
From: 
Date
Time:  (e.g., 10:30 AM)
To: 
Date
Time:  (e.g., 11:25 PM)
 
Add a Garmin Navigation system at $10 a day
I would like the Unlimited Miles option.

Terms And Conditions

Please be aware of your requested pickup and return times on this form! Rental charges will start and end on those specific dates and times. By entering my initials into this box, I am acknowleging my deposit is non-refundable and adhere to the policies of Bedford Auto Rentals.


"Once unlimited mileage is chosen, you will adhere to that mileage option". Please do your mileage math before choosing. No adjustments will be made at end of rental term

Please be aware before doing so.
By entering my initials into this box, I am acknowleging my deposit is non-refundable and adhere to the policies of Bedford Auto and Van Rentals.
 
Vehicle Type: Qty: Unit Price: Price:
Deposit $
   
    Subtotal: