Book an Insurance Replacement Vehicle

Excel Network Rent a Car is a wholly South Australian owned and operated family business.

INSURANCE DETAILS
Insurance Company*
Claim Number*
Name of Repairer
Vehicle Being Repaired
Approximate Number of Days
DRIVER DETAILS
First Name**
Last Name**
Hidden
Date of Birth*
Date of Birth*
DD slash MM slash YYYY
Driver's Licence Number**
State**
Hidden
Licence Expiry Date
Licence Expiry Date*
DD slash MM slash YYYY
CONTACT DETAILS
Street Address**
Suburb**
State**
Postcode**
Country**
Work Phone**
Home Phone**
Mobile Phone**
Email**
VEHICLE DETAILS
Vehicle Type*
BOOKING DETAILS
Hidden
Pickup Date
Pickup Date*
DD slash MM slash YYYY
Pickup Location*
Time*

: HH

MM

AM/PM
Hidden
Return Date
Return Date*
DD slash MM slash YYYY
Return Location*
Time*

: HH

MM

AM/PM
Select Payment Method
Payment Method Selection
- Credit/Debit Card Security Number
Card Type*
*There will be a 4% surcharge on all American Express and Diners Club Card Payments.
Name on Card*
Card Number*
CVV*
Expiry Date*
Our vehicles are full of fuel and are required to be returned the same way and all vehicles are non-smoking and no animals are allowed ($150 cleaning fee applies). In the event of an accident there is a $2500 excess. You are required to pay this however you can then lodge a claim with your own insurance company, in which case you will be reimbursed less your applicable excess.
Acknowledge have read conditions*
- I acknowledge that I've read and understood these conditions.
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Call 08 8234 1666

Fax: (08) 7225 8570
Email: info@excelrentacar.com.au

Address: 1 Weaver Avenue, Richmond SA 5033