White Goods
Fitness Equipment
Furniture and Bedding
Heating and Cooling
Audio and Visual
Coffee Machines
Cool Rooms and Toilets
Computers
Mobility Scooters
 
On-line Application Form


Thank you for choosing Rentals-R-Us for delivery in Perth, Western Australia.


Please complete the following form with as much detail as you have available.

ENTER THE PRODUCT & PERIOD (MONTHS) YOU WISH TO RENT FOR:
(if possible please include product description...eg 5Kg washer and 220ltr fridge)

SURNAME NAME

FIRST NAME

MIDDLE NAME

DRIVERS LICENSE

BIRTH DATE (DAY/MONTH/YEAR)

PHONE

MOBILE

EMAIL


May we have your permission to keep your email address on record to notify you of any specials or bargains in the future? Yes

ADDRESS

HOW LONG? YEARS MONTHS

ALLOW CREDIT CHECK (Permission to do a credit check?)

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