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EPSILON RENT A CAR

SECURE RESERVATION FORM


 
Last name:
First name:
Address: 
City: 
State/Prov: 
Country:
   Postal Code:  Your e-mail:
Include country & area codes. Tel:   Fax: 

To better answer your enquiry, please supply the following information:
 
Enter preferred Car Make and Model/Type: 


Please indicate all dates below,  in DD/MM/YY format, ie: 25/6/98
Preferred dates:  From: 
to:  No of days: 
Name of hotel where you are staying:

Where would you like the car delivered to:
Delivery Time
(if airport, indicate Airline name, flight No. & arrival time):   

Mobile Phone Number (which you are planning to use on the Island of Rhodes):

 

* COMPLETE THIS SECTION ONLY IF YOU ARE CONFIRMING A RESERVATION *

This is a Secure Server and all data is processed using 128 bit encryption. Therefore, we can only accept confirmed reservations if the information below is completed in full.
   Visa/Eurocard Mastercard    Name on card:  
 Credit Card number:   Expiry date:  
*CVV/CVC
                                               *(Last 3 digits on the back of your card, to the right of your signature)

Please note: If your reservation is accepted, your credit card information will be kept for guarantee purposes only.

Comments: Please type any comments, or special instructions below.

 

NOTE: All fields indicated in red must be completed.
I accept the above Terms & Conditions
 


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