Customer Profile
* Last Name
* First Name
* E-mail
* Phone
P.O. #
Claim #
Insurance Company Name
Payment Type
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MasterCard
Visa
AMEX
Discover
(Payment will be accepted at time of rental.)
Rental Details
* Location Van is Needed:
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ΚΚΚΚΚΚΚΚΚΚΚ
Abilene
Baton Rouge
Beaumont, Orange, Port Arthur
Dallas, Plano, Frisco
Ft. Worth
Houston
Lubbock
New Orleans
San Antonio
Shreveport
Tyler, Longview
Waco, Temple, Killeen
Pick Up Date
(MM/DD/Year)
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2011
2012
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Pick Up Time
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:
15
30
45
00
AM
PM
Full Size Van with Lift
Daily Rental $89.00
Weeky Rental
Monthly Rental
(Rental includes 125 miles per day, $0.35 per mile thereafter.)
Mini Van with Ramp
Drop Off Date
(MM/DD/Year)
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/
2011
2012
2013
2014
Drop Off Time
1
2
3
4
5
6
7
8
9
10
11
12
:
15
30
45
00
AM
PM
As a condition of renting a vehicle from WAV, you will be required to accept and sign our terms and conditions document upon pick up.
* Required Field
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