Enrolment Form and Profile - Budget Rent a Car
Enrolment Form and Profile - Budget Rent a Car
Enrolment Form and Profile - Budget Rent a Car
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Master <strong>Rent</strong>al Agreement - <strong>Enrolment</strong> <strong>Form</strong> <strong>and</strong> <strong>Profile</strong><br />
1<br />
2<br />
REQUIRED INFORMATION<br />
RapidRez Number (if applicable)____________________________________________ Title Mr. Ms. Mrs. Miss Other<br />
Surname ________________________________________________________________ First Name ________________________________________ Middle Initial<br />
PERSONAL INFORMATION<br />
Please use block letters<br />
Company Name (if applicable)________________________________________________________<br />
Company Address (if applicable)_________________________________________<br />
Home Address________________________________________________________<br />
Yes, send me <strong>Budget</strong> email specials<br />
<strong>Budget</strong> Customer Discount Number (BCD)<br />
(if applicable)<br />
_________________________<br />
Suburb__________________________ State___________ Postcode_______________<br />
Suburb__________________________ State___________ Postcode_______________<br />
If PO Box given as a mailing address, full address is also required________________________________________________________________________________________<br />
Suburb__________________________ State___________ Postcode ____________ Preferred Mailing Address Home Company<br />
Email<br />
Email Address________________________________________________________________________________________________<br />
By including your email address, you consent to receiving all notices under the <strong>Budget</strong> Fastbreak Service (including amendments to the Terms <strong>and</strong> Conditions applicable to the Service) by email.<br />
Yes, send me electronic receipts<br />
Daytime Phone _____________________________________________ Driver’s Licence Number _________________________________ Date of Birth_____/_____/_____<br />
You must hold a current licence (not being a learner’s licence or provisional licence) <strong>and</strong> have been licensed to drive for at least 12 consecutive months. Note: if your overseas driver’s licence is not in<br />
English, you must forward a copy of your International Driver’s Permit to <strong>Budget</strong>.<br />
3<br />
4<br />
5<br />
ASSOCIATION MEMBER<br />
NRMA/RACQ/RACV Seniors Australian Medical Association Other Name of Association_____________________________________________<br />
Membership Number_______________________________________________<br />
FREQUENT TRAVELLER PROGRAM<br />
(Choose one only)<br />
Please complete the membership number for the frequent traveller program you wish to be credited for qualifying <strong>Budget</strong> rentals. Please include alpha prefix.<br />
Qantas Frequent Flyer Airpoints (Air New Zeal<strong>and</strong>) Mileage Plus (United Airlines) FlyBuys Australia<br />
Other ________________________________________________<br />
CHARGE CARD BILLING INFORMATION<br />
Type of card: Diners Club Master<strong>Car</strong>d Amex Visa <strong>Budget</strong><br />
Membership Number___________________________________________________<br />
The following amounts will be debited to your nominated charge card below: (1) all <strong>Budget</strong> rental charges <strong>and</strong> fees in relation to the <strong>Budget</strong> Fastbreak Service at the time of rental; <strong>and</strong> (2) all tolls <strong>and</strong> fees<br />
after they are incurred or notified to RMS by a toll road operator (see Section 8 below).<br />
Primary <strong>Car</strong>d Number _________________________________________________________________________________________________ Expiry Date MTH I YR<br />
Alternative <strong>Car</strong>d Number _________________________________________________________________________________________________ Expiry Date MTH I YR<br />
Note: Cash, cheques, debit cards <strong>and</strong> vouchers cannot be used for this Service.<br />
If you do not already hold a <strong>Budget</strong> charge card <strong>and</strong> you wish to have: (1) your <strong>Budget</strong> rental charges <strong>and</strong> fees debited to the Company’s account with <strong>Budget</strong><br />
above <strong>and</strong> (2) Your tolls <strong>and</strong> fees debited to the Company’s account with RMS above (see Section 8 below), please ensure this section is signed by someone of<br />
authority in the Company other than you.<br />
I HEREBY AUTHORISE THE ABOVE APPLICANT TO BE ISSUED WITH A BUDGET CHARGE CARD LINKED TO THE COMPANY ACCOUNT NO.: BU869...........................................................<br />
AND I AUTHORISE (1) ALL RENTAL CHARGES, FEES, COSTS AND AMOUNTS INCURRED BY THE APPLICANT (INCLUDING FOR THE OPTIONAL SERVICES/COVERAGES ‘ACCEPTED’<br />
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).<br />
Name____________________________________________ Signature 8__________________________________ Position________________________________________<br />
6<br />
OPTIONAL SERVICES/COVERAGES<br />
Please read the applicable sections of the attached <strong>Budget</strong> Fastbreak Service Terms <strong>and</strong> Conditions booklet before completing this part of the <strong>Enrolment</strong> <strong>Form</strong>.<br />
The information below is a guide only <strong>and</strong> is subject to those Terms <strong>and</strong> Conditions. Charges <strong>and</strong> options for services <strong>and</strong> coverages (in this<br />
form, each a ‘service’) vary by country <strong>and</strong> are subject to change without notice. Please check the <strong>Budget</strong> website at: www.budget.com.au for<br />
all current charges <strong>and</strong> terms <strong>and</strong> conditions applicable to a service at the time of rental.<br />
Please Initial<br />
Loss/Collision Damage Waiver<br />
Limits your financial responsibility for loss or damage to the <strong>Budget</strong> vehicle <strong>and</strong> in some countries third party property damage or injury (if you<br />
comply with the <strong>Budget</strong> <strong>Rent</strong>al Agreement). In some cases an excess amount is payable. May not be available from all <strong>Budget</strong> locations.<br />
It is included in most rates in Australia. Known as:<br />
• Motor vehicle Insurance (MVI) (in New Zeal<strong>and</strong>) (compulsory for a renter not domiciled in NZ) • Collision Damage Waiver (CDW) (in Europe) •<br />
Loss Damage Waiver (LDW) (in USA/Canada)<br />
The following services are available at selected locations in Australia:<br />
Excess Reduction (ER)<br />
In Australia, ER reduces your excess amount (see above section). Varies by age of renter, location, type of vehicle <strong>and</strong> rate. Note: ER does not<br />
cover certain loss or damage.<br />
Portable GPS<br />
_______<br />
Accept<br />
_______<br />
Accept<br />
_______<br />
Accept<br />
_______<br />
Decline<br />
_______<br />
Decline<br />
_______<br />
Decline<br />
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.<br />
You will, therefore, not have the benefit of such service <strong>and</strong> may be responsible for all loss or damage to a vehicle depending on the terms <strong>and</strong><br />
conditions of the <strong>Budget</strong> <strong>Rent</strong>al Agreement in the country where the rental takes place.<br />
Continue over<br />
CT9006A
Master <strong>Rent</strong>al Agreement - <strong>Enrolment</strong> <strong>Form</strong> <strong>and</strong> <strong>Profile</strong> (Page 2)<br />
7<br />
car group preference<br />
X - Economy - manual/air-con<br />
A - Compact - manual/air-con<br />
B - Compact - auto/air-con<br />
C - Intermediate - auto/air-con<br />
D - St<strong>and</strong>ard - auto/air-con<br />
E - Full Size - auto/air-con<br />
(Select One Only)<br />
P - Full Size Premium - auto/air-con<br />
F - Full Size Wagon - auto/air-con<br />
G - Premium - auto/air-con<br />
H - Luxury - auto/air-con<br />
V - Full Size Van - auto/air-con<br />
8<br />
ACKNOWLEDGEMENT, AGREEMENTS, PRIVACY CONSENTS AND AUTHORISATION<br />
By signing below:<br />
1. you acknowledge that you have read <strong>and</strong> understood this form <strong>and</strong> the <strong>Budget</strong> Fastbreak Service Terms <strong>and</strong> Conditions attached to this form (<strong>Budget</strong><br />
Fastbreak Service Terms <strong>and</strong> Conditions);<br />
2. you agree to be bound by the <strong>Budget</strong> Fastbreak Service Terms <strong>and</strong> Conditions as amended from time to time <strong>and</strong> as located on the <strong>Budget</strong> website, including:<br />
(a)<br />
(b)<br />
(c)<br />
(d)<br />
(e)<br />
(f)<br />
that you are liable for the loss of <strong>and</strong> all damage to the Vehicle unless this liability is reduced (see above);<br />
that, depending on the country of rental, you are always liable for the Excess Amount (<strong>and</strong> additional charges) <strong>and</strong> certain damage to the vehicle;<br />
(Australia only) the ‘RMS E-Toll Facility Terms <strong>and</strong> Conditions for the <strong>Budget</strong> Fastbreak Service’ (including the obligation to pay to Roads <strong>and</strong> Maritime<br />
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<br />
out in the <strong>Budget</strong> Fastbreak Service Terms <strong>and</strong> Conditions;<br />
the applicable <strong>Budget</strong> Privacy notices <strong>and</strong> policies;<br />
the ‘RMS Privacy Consent <strong>and</strong> Agreement for the <strong>Budget</strong> Fastbreak Service’; <strong>and</strong><br />
those services <strong>and</strong> coverages above which are included or which you have accepted by initialling,<br />
each as set out in the <strong>Budget</strong> Fastbreak Service Terms <strong>and</strong> Conditions;<br />
3. you consent to <strong>Budget</strong> (as defined in the ‘Australian Terms <strong>and</strong> Conditions’ of the <strong>Budget</strong> Fastbreak Service Terms <strong>and</strong> Conditions) <strong>and</strong> RMS disclosing your<br />
information to entities located outside Australia for the purposes set out in the ‘<strong>Budget</strong> Australia Privacy Notice’ <strong>and</strong> the ‘RMS Privacy Consent <strong>and</strong> Agreement<br />
for the <strong>Budget</strong> Fastbreak Service’ respectively (each set out in the <strong>Budget</strong> Fastbreak Service Terms <strong>and</strong> Conditions), on the basis that neither <strong>Budget</strong> nor RMS<br />
is required to ensure that any overseas recipient complies with Australian privacy laws; <strong>and</strong><br />
4. you authorise:<br />
(a)<br />
(b)<br />
<strong>Budget</strong> to debit all rental charges, fees, costs <strong>and</strong> amounts; <strong>and</strong><br />
RMS to debit all tolls <strong>and</strong> fees,<br />
to your nominated charge card above.<br />
Tick this box if you do not want <strong>Budget</strong> to use your information to send you details about products <strong>and</strong> services which are provided by <strong>Budget</strong> or any of its related companies, licensees <strong>and</strong> program partners.<br />
Signature 8_______________________________________________________________________________________ Date____________________________________<br />
Print Name<br />
______________________________________________________________________________________<br />
Send this completed form to:<br />
<strong>Budget</strong> Fastbreak<br />
Reply Paid 79040<br />
Mascot NSW 2020<br />
or<br />
Fax: 1800 006 476<br />
Any questions, please contact:<br />
Email: fastbreak@budget.com.au<br />
Tel: 1800 150 278<br />
<strong>Budget</strong> <strong>Rent</strong> a <strong>Car</strong>, Level 2, 15 Bourke Road, Mascot, NSW 2020. Fastbreak Helpline 1800 150 278. Facsimile 1800 006 476.<br />
<strong>Budget</strong> <strong>Rent</strong> a <strong>Car</strong> Australia Pty Ltd - ABN 89 007 348 021