Orkney Car & Van Hire

Reservation Form

Personal Details

Title*

Forename*

Surname*

Address*

Postcode*

Email*

Telephone*

Mobile*

Date of Birth* Drivers must be over 21 (Terms and Conditions)

Occupation*

Driving Licence Number*

National Insurance No or Check Code (UK Licence Holders) If UK License Holder please supply National Insurance Number or Driver Licence Check Code available here. National Insurance number is not mandatory but we will need either National Insurance or UK License check code. UK Licence holders only. This is so we can check your Licence details prior to hire, which will speed up the paperwork process.

Additional Drivers Name, DOB, Licence Number

Insurance Proposal Leseor's Insurance

Have you had a proposal declined, a policy cancelled or renewal refused or been required to pay an increased premium or had special conditions imposed by any motor insurance?*

Have you any physical or mental defect or infirmity or suffer from diabetes,fits or any heart condition?*

Have you been convicted of any motering offence during the last five years, or had your licence suspended during the last ten years, or is any prosecution pending?*

Have you had any accidents and/or claims in the past 36 calendar months?*

Hire Requirements Rental Start

Start Date*

Start Time*

Flight Number

Departure Airport

Pick Up From*

Hire Requirements Rental End

End Date*

End Time*

Drop Off To*

Vehicle Group Type*

Collision Damage Insurance* Click here for Terms and Conditions

Additional Requirements

Number of Adults*

Number of Children*

Booster Seat 15kg. - 25kg. 4 Years - 6 Years

Card Details

Card Type*

Issue Number (Switch)

Card Number*

Start Month*

Start Year*

Expiry Month*

Expiry Year*

Security Code*

Click check box when you have read our Terms and Conditions*