Easy Life
Fax Inquiry / Booking

 

                   to:               Easy Life Tours & Rentals Australia
                                      att. Pia
                                      Phone:                        0061 7 5494 7961
                                      Fax:                             0061 7 5406 0958
                                      Email:                          pia@easylife.net.au

 

from:                                                                phone:                                                            

                                                                       fax/email:                                                        

Where did you get our address from?                                                                                       

 

 

Please send an offer:   [  ]                       a contract:   [  ]

 

vehicle:                                                                                                                                  

EMU2 or EMU3 (2 and 3-berth camper), EMU4 or EMU6 (motorhomes), B2B (campervan)

Period from:                                                          to:                                                              

 

Pick up:                                                                Drop off:                                                     

Cover options:       [  ] BC             [  ] ER1          [  ] ER2            [  ] AIR3

 

Number of adults:                                                  children:                age of children:               

Special needs:                                                                                                                       

                                                                                                                                             

Date of arrival:                         flight no:                       time:                        airline:                    

 

Date of departure:                   flight no:                       time:                        airline:                    

 

Surname:                                                              first name:                                                  

Address:                                                                                                                                

Date of birth:                                                         attainable till:                                              

Phone No:                                                            Fax No or e-mail:                                        

Passengers name & date of birth:                                                                                            

                                                                                                                                             

deposit payable by:            creditcard [  ]
the balance:                      bankaccount [  ]          creditcard [  ]    cash [  ]   

Mastercard   |_|         Visa   |_|      Name on card:                                                                      

Card no.         |_|_|_|_|  |_|_|_|_|  |_|_|_|_|  |_|_|_|_|
exp. date:       |_|_| / |_|_|
ver. code:       |_|_||_| (last 3 digits on signature strip on back of card)