Please provide the following contact information:

First Name
Last Name
Title
Company
Street Address
Address (cont.)
City
Province
Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Please choose the style of Golf Cart you wish to rent:

Regular Golf Car Golf Car with Additional Seat Golf Car with Utility Box Utility Vehicle 6 Passenger Shuttle
 

Please choose the motor style of the Golf Cart:

Gas Electric
 

Please choose the lighting options for the Golf Cart:

Head Lights required  Tail Lights required   No Lights required    

Please provide your required Rental START DATE:

-- mm/dd/yy
 

Please enter your required rental COMPLETION date:

-- mm/dd/yy
 

Please enter the location where the Golf Cart will be used

Lessee provides insurance information:

Yes No
 

Please enter your Insurance Company and Policy Number the Golf Cart will be covered by:

Your Golf Cart will be billed to which Credit Card?

Visa Mastercard
 

Please provide your credit card number:

Please provide expiry date:

-- mm/dd/yy
 

Please enter your Credit Cards Security Code:

Please enter your name below as it appears on your credit card. This will serve as your signature to this rental request, and you have read and understand the terms of our agreement. You are also serve as your ELECTRONIC SIGNATURE to this form, and that you agree to the billing of your credit card for your Golf Cart rental.

Please enter your name below as it appears on your credit card. This is your electronic signature to this rental request.

PLEASE NOTE! - This is an APPLICATION ONLY, a representative will contact you shortly to confirm the rental cart you have chosen is available for the dates you have provided.

THANK YOU! again, for choosing CENTRAL CART SERVICES! your business is greatly appreciated.