Car Booking Rental Form

Vehicle Rental Details

Please Fill in the Blanks

• Existing Customer ? *
  Please selectYes, I am an existing customerNo, this is my first time
• I.C No / Passport No *
• Name *
  FirstMiddleLast
• Address *
  Street AddressCityState / Province / RegionPostal / Zip Code Antigua and BarbudaArubaBahamasBarbadosBelizeCanadaCayman IslandsCook IslandsCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNetherlands AntillesNicaraguaPanama Puerto Rico Saint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColombiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFaroe IslandsFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyKosovoLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican City AfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorHong KongIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPalestinePhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosDemocratic Republic of the CongoRepublic of the CongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGibraltarGuineaGuinea-BissauCote d'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandUnited Republic of TanzaniaTogoTunisiaUgandaZambiaZimbabweCountry / Region
• Email *
• Phone *
  ###-###-####
• Model of Vehicle *
  Select The Model of CarPerodua VivaPerodua MyviPerodua AlzaProton SagaProton PersonaProton WiraHonda AccordHonda CivicToyota VelfireToyota InnovaToyota HiaceToyota ViosChevrolet CruzeHyundai Accent
• Type of Rental *
  Please SelectHourlyDailyHalf DayWeeklyMonthly
• Purpose / Destination *
• Rental Period *
• Delivery Date & Time *
  DD/MM/YYYYHH:MMAMPMAM/PM
• Delivery Location *
• Return Date & Time *
  DD/MM/YYYYHH:MMAMPMAM/PM
• Return Location *
• Comment or Request *
• Please provide these information to us upon inquiry:
  Copy of I/C and/or Passport and/or Visa (Front and Back)

  Copy of valid Malaysian or International Driving License (Front and Back)

  Copy of Student and/or staff ID (Front and Back)

  Copy of Utility bills
• Do you agree with the Terms & Conditions of Eazy Peezy Car Rental?
  Yes, I strongly agree and I would like to proceed with registration

  No, I do not agree and I would like to cancel registration

Terms and Conditions