Please provide the following contact information:

First Name:   

Last Name:    

Company Name: 

Address:      

Address(cont):

City:          State/County:  Zip/Postal Code: 

Country:      

Home Phone:   Work Phone:   

Fax:          

E-mail:       

Choose one of the following cars : group A - Renault Twingo or similar group B - Citroen Saxo or similar group C - Volkswagem Polo or similar group D - Renault Megane or similar group D1 - Volkswagem Polo "open air" or similar group E - Volkswagem Golf or similar group F - Volkswagem Golf Station or similar group G - Volkswagem Kombi "minibus - 9 seats" or similar group H - Ford Fiesta automatic or similar group I - Renault 19 RTI "air con" or similar group J - Volkswagem Sharan "air con/ luxe" or similar

Extras:
roof rackbaby seatP.A.I 1st add.driver 2nd add.driver



date of deliverie.:dd/mm/yy time: hh:mm

date of returning:dd/mm/yy time: hh:mm


delivered at:arrival Flight number:

collected at:.depart Flight number:



Payment Options:

Pay by Credit Card

Card: MasterCard Visa American Express Discover Please Select Card Number:
Expiration Date: January February March April May June July August September October November December ---------------- 2003 2004 2005 -------

Pay by Check

Please send the total amount to:

José Caniné,Lda
Apartado 2225
8135-117 Almancil
Algarve Portugal

Special Requests:

Thank You For Your Order!