Fastbreak Master Rental Agreement - Budget Truck Rentals
Fastbreak Master Rental Agreement - Budget Truck Rentals
Fastbreak Master Rental Agreement - Budget Truck Rentals
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REQUIRED INFORMATION<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 />
<strong>Master</strong> <strong>Rental</strong> <strong>Agreement</strong> - Enrolment Form and Profile<br />
Please use block letters<br />
RapidRez Number (if applicable) ___________________________________________ Title Mr. Ms. Mrs. Miss Other<br />
Surname _______________________________________________________________ First Name _______________________________________ Middle Initial<br />
PERSONAL INFORMATION<br />
<strong>Budget</strong> Customer Discount Number (BCD)<br />
Company Name (if applicable) _______________________________________________________ (if applicable)<br />
________________________<br />
Company Address (if applicable) ________________________________________ Suburb _________________________ State __________ Postcode ______________<br />
Home Address _______________________________________________________ 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 Yes, send me <strong>Budget</strong> email specials Email Address _______________________________________________________________________________________________<br />
By including your email address, you consent to receiving all notices under the <strong>Budget</strong> <strong>Fastbreak</strong> Service (including amendments to the Terms and Conditions applicable to the Service) by email.<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 Air Points (Air New Zealand) Mileage Plus (United Airlines) FlyBuys Australia<br />
Other _______________________________________________ Membership Number __________________________________________________<br />
CHARGE CARD BILLING INFORMATION<br />
The following amounts will be debited to your nominated charge card below: (1) all <strong>Budget</strong> rental charges and fees in relation to the <strong>Budget</strong> <strong>Fastbreak</strong> Service at the time of rental; and (2) all tolls and fees<br />
after they are incurred or notified to the RTA by a toll road operator (see Section 8 below).<br />
Type of card: Diners Club <strong>Master</strong>Card Amex Visa <strong>Budget</strong><br />
Primary Card Number ________________________________________________________________________________________________ Expiry Date MTH I YR<br />
Alternative Card Number ________________________________________________________________________________________________ Expiry Date MTH I YR<br />
Note: Cash, cheques, debit cards and vouchers cannot be used for this Service.<br />
If you do not already hold a <strong>Budget</strong> charge card and you wish to have: (1) your <strong>Budget</strong> rental charges and fees debited to the Company’s account with <strong>Budget</strong><br />
above and (2) Your tolls and fees debited to the Company’s account with the RTA 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 THE RTA (SEE SECTION 8 BELOW).<br />
Name ___________________________________________ Signature 8 _________________________________ Position _______________________________________<br />
OPTIONAL SERVICES/COVERAGES<br />
Please read the applicable sections of the attached <strong>Budget</strong> <strong>Fastbreak</strong> Service Terms and Conditions booklet before completing this part of the Enrolment Form.<br />
The information below is a guide only and is subject to those Terms and Conditions. Charges and options for services and coverages (in this<br />
form, each a ‘service’) vary by country and are subject to change without notice. Please check the <strong>Budget</strong> website at: www.budget.com.au for<br />
all current charges and terms and conditions applicable to a service at the time of rental.<br />
Loss/Collision Damage Waiver<br />
Limits your financial responsibility for loss or damage to the <strong>Budget</strong> vehicle and in some countries third party property damage or injury (if you<br />
comply with the <strong>Budget</strong> <strong>Rental</strong> <strong>Agreement</strong>). 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 Zealand) (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 and rate. Note: ER does not<br />
cover certain loss or damage.<br />
Portable GPS<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) and 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 />
Please Initial<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 and may be responsible for all loss or damage to a vehicle depending on the terms and<br />
conditions of the <strong>Budget</strong> <strong>Rental</strong> <strong>Agreement</strong> in the country where the rental takes place.<br />
CONTINUE OVER<br />
_______<br />
Accept<br />
_______<br />
Accept<br />
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Accept<br />
_______<br />
Decline<br />
_______<br />
Decline<br />
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Decline
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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 - Standard - auto/air-con<br />
E - Full Size - auto/air-con<br />
(Select One Only)<br />
ACKNOWLEDGEMENT, AGREEMENTS, PRIVACY CONSENTS AND AUTHORISATION<br />
By signing below:<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 />
1. you acknowledge that you have read and understood this form and the <strong>Budget</strong> <strong>Fastbreak</strong> Service Terms and Conditions attached to this form (<strong>Budget</strong><br />
<strong>Fastbreak</strong> Service Terms and Conditions);<br />
2. you agree to be bound by the <strong>Budget</strong> <strong>Fastbreak</strong> Service Terms and Conditions as amended from time to time and as located on the <strong>Budget</strong> website, including:<br />
(a) that you are liable for the loss of and all damage to the Vehicle unless this liability is reduced (see above);<br />
(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;<br />
(c) (Australia only) the ‘RTA E-Toll Facility Terms and Conditions for the <strong>Budget</strong> <strong>Fastbreak</strong> Service’ (including the obligation to pay to the Roads and Traffic<br />
Authority of NSW ABN 64 480 155 255 (RTA) the RTA 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> <strong>Fastbreak</strong> Service Terms and Conditions;<br />
(d) the applicable <strong>Budget</strong> Privacy notices and policies;<br />
(e) the ‘RTA Privacy Consent and <strong>Agreement</strong> for the <strong>Budget</strong> <strong>Fastbreak</strong> Service’; and<br />
(f) those services and coverages above which are included or which you have accepted by initialling,<br />
each as set out in the <strong>Budget</strong> <strong>Fastbreak</strong> Service Terms and Conditions;<br />
3. you consent to <strong>Budget</strong> (as defined in the ‘Australian Terms and Conditions’ of the <strong>Budget</strong> <strong>Fastbreak</strong> Service Terms and Conditions) and the RTA disclosing your<br />
information to entities located outside Australia for the purposes set out in the ‘<strong>Budget</strong> Australia Privacy Notice’ and the ‘RTA Privacy Consent and <strong>Agreement</strong><br />
for the <strong>Budget</strong> <strong>Fastbreak</strong> Service’ respectively (each set out in the <strong>Budget</strong> <strong>Fastbreak</strong> Service Terms and Conditions), on the basis that neither <strong>Budget</strong> nor RTA<br />
is required to ensure that any overseas recipient complies with Australian privacy laws; and<br />
4. you authorise:<br />
(a) <strong>Budget</strong> to debit all rental charges, fees, costs and amounts; and<br />
(b) RTA to debit all tolls and 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 and services which are provided by <strong>Budget</strong> or any of its related companies, licensees and program partners.<br />
Signature 8 ______________________________________________________________________________________ Date ___________________________________<br />
Print Name ______________________________________________________________________________________<br />
Send this completed form to:<br />
<strong>Budget</strong> <strong>Fastbreak</strong><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>Master</strong> <strong>Rental</strong> <strong>Agreement</strong> - Enrolment Form and Profile (Page 2)<br />
<strong>Budget</strong> Rent a Car, Level 2, 15 Bourke Road, Mascot, NSW 2020. <strong>Fastbreak</strong> Helpline 1800 150 278. Facsimile 1800 006 476.<br />
<strong>Budget</strong> Rent a Car Australia Pty Ltd - ABN 89 007 348 021