Send us Enquiries for Car and Van Hire Burton, Lichfield and Tamworth

Burton: 01283 539 123
Lichfield: 01543 417 755
Tamworth: 01827 289 888

Enquiry Form

	Please tick the box to confirm that you are of 24 years or over plus that you have
	been driving for a minimum of 24 months.

Name in Full

Telephone No.

Address

Date of Birth

Age

Occupation

Over

Driving license number

Any Disabilities

* If "Yes" please state below

Are you a Student

Driving over 24 months

Catagory of Vehicle

Type of Vehicle Prefered

Hire Period:

Hire Period-Time:

Start Date		Finish Date	*
Pick up time		Drop off time	*

Had any endorsements within the last 10 years ?
Ever been banned from driving ?
Had any fault accident within the last 3 years ?

( * denotes mandatory fields)