Privilege Ready Card enrolment

A) Identification

1. Do you already possess:

A Europcar card?

If YES, please indicate which...

For "Other", please specify which...

Yes       No

A Europcar ID number?

If YES, please indicate the number...

Yes       No

A Europcar Contract number?

If YES, please indicate the contract number...

Yes       No

2. Personal details:

Mr.       Mrs.       Miss       Dr.       Other  

First Name *

Last Name *

Date of birth *

dd/mm/yyyy

City of birth *

Country of birth *

Language preference *

3. Home contact details:

All correspondence will be sent to your home address. The only exception is for employees of companies that have been set up with a EUROPCAR charge account.

Address *

Town / City *

County / State

Postcode / ZIP

Country *

Telephone No.

Home e-mail address

4. Company contact details:

Job title

Company ISO activity code (if known)

Address

Company name

Town / City

County / State

Postcode / ZIP

Country

Telephone No.

Fax No.

Office e-mail address

5. Driving licence information:

Licence No. *

Issue date *

Expiry date

dd/mm/yyyy

dd/mm/yyyy

Issue city *

Issue country *

6. Passport information:

Passport       Identity card

Passport / ID No.

Issue date

Expiry date

dd/mm/yyyy

dd/mm/yyyy

Issue city

Issue country

7. Frequent Flyer / Membership Programme Information:

This information can be used to access your Europcar profile and could also entitle you to additional rental discounts.

Card 1

Name
(eg Air France Frequence Plus / Alitalia Millemiglia)

Card Number

Expiry date
dd/mm/yyyy

Card 2

Name
(eg Air France Frequence Plus / Alitalia Millemiglia)

Card Number

Expiry date
dd/mm/yyyy

B) Ready Service Enrolment

8. Waiver / Insurance

These insurance preferences will apply if you do not have a Europcar contractual rate, or if the contractual rate does not include the insurance coverage you would like.

Accept       Decline

CDW / DW - Cover in case of damage to the vehicle

Accept       Decline

TW - Cover in case of theft of the vehicle

Accept       Decline

PAI / PAEC - Personal Accident Insurance

9. Means of Payment

In order of preference, please provide details of up to 2 credit cards you wish to use to pay for your Europcar Ready rentals. The first credit card listed will be your primary method of payment, the second will only be used if the first is not valid and is required when renting luxury or premium vehicle. The second credit card is not mandatory, but if omitted, may compromise the level of Ready service available. Charge account / central billing customers should ensure that credit card details are completed to enable us to process your application.

Card 1

Type of Card *

Credit Card Number *

Card 2

Type of Card

Credit Card Number

DECLARATION

• I confirm that the information I have provided on this form is true and correct. I also confirm that I have read , understand and agree to the General Conditions available on www.europcar.com. I undertake to notify Europcar of any change in the above information in writing to the Sales Administration department of my country of residence.


• Lastly, I am informed that this information is optional but necessary to obtain the Privilege card and will be stored on a computerised database which I can consult at any time to review and rectify my personal data on request at Europcar headquarter of my country of residence.

Date: ____ / ____ / ____

Signature (must be signed to be eligible): ___________________________________

Data Protection
It is EUROPCAR standard practice to use its customer database for promotional mailings by EUROPCAR or its business partners. Should you, for any reason, not wish to receive such mailings, please tick this box.