Motorcycle Rental and Tour Reservation Form

Reserve early to avoid disappointment!

Mission Motos SARL INTERNET www.missionmotos.biz
Once you are sure you want to book, proceed as follows : :
• Fill out this form and print it
• If you’re paying by credit card, fax or scan and e-mail the form . For payments by cheque or bank transfer, send the form in with payment.
• If you require any advice please do not hesitate to contact us :

Fax : 00 33 561 796 186 Phone : 00 33 672 094 354 E-MAIL Contact@MissionMotos.Biz
Post : Mission Motos, Chemin De Traversolles, Hameau Taillebourg, 31210 Ponlat Taillebourg, France,

Mr / Mrs / M/s _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ E-Mail: Address: ___________________

Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _

Town and Postal Code_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Téléphone _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Fax _ _ / _ _ / _ _ / _ _ / _ _

Mobile _ _ / _ _ / _ _ / _ _ / _ _

Driving License : N° _ _ _ _ _ _ _ _ _ _ _ _ _ Issued at _ _ _ _ _ By _ _ _ _ _ _ _ _

Moto booked : Tour Booked :

Place / Date / Time DEPART : Place/ Date / Time RETURN :

Deposit : < 700 CC - 1500 Euros > 700 CC 3000 euros = ___________ Euros

Hire Amount : _ _ _ _ _ _ __ _

Transport Amount : _ _ _ _ _ _ __ _

Tour Amount: : _ _ _ _ _ _ __ _

Total Amount: : _ _ _ _ _ _ __ _

I authorise the following Transactions: Signature: _________________________________________________

Deposit - ____/_____/______ -10% of Hire Amount = ______________ (minimum 30) Euros

____/_____/______ - (1 week before drop-off) ______________ Euros (Transport Amount) Plus ___________ Euros pre-authorisation on deposit,

____/_____/______ - (1 Day prior to start of transport) ______________Euros (90% of Hire Amount)

________________________________________________________________________________________________________________________________

Page 2:

Note - If you prefer to pay through PayPal we will add 1.5% admin charge - which is our extra cost on the transaction.

If you wish to pay by Paypal please leave your credit card details blank and tick here __________

Mode : Card N°                            _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Expiration Date :                                             — — / — —
Last 3 numbers on the back of your card :       __ __ __

I have read the terms and conditions of hire Full terms and conditions on our contract - please ask for a copy.

Signed at Date

Customer Signature :

___________________________________________________________________________________________________________________________________

For Office use:

Reservation Taken Date:

Deposit taken Date:

Balance Taken Date

Destroy Page 2 Date

(One Month after completion of hire if bike undamaged)

Home Page

_______________________________________________________________________________________________________________________