Malaysia Car Rental | Kuala Lumpur Car Rental | Shajasa: Car Rental Reservation Form

Car Rental Reservation Form

To facilitate us in processing your reservation, kindly provide details for all fields.

Please allow us 48 hours to respond.

PERSONAL INFORMATION
Title:
First Name*:
Last Name*:		Age:

CAR INFORMATION
Car Type:		Duration:
Number of Persons:	(Adults) (Children)

PICK-UP INFORMATION
		Pick-up Location:	Kuala Lumpur KLCC KLIA (Airport) LCCT (Airport) Selangor Klang Petaling Jaya Hotel in Kuala Lumpur* Hotel in Selangor* *Please specify hotel.
Pick-up Date:
Pick-up Time:


RETURN INFORMATION
		Return Location:	Kuala Lumpur KLCC KLIA (Airport) LCCT (Airport) Selangor Klang Petaling Jaya Hotel in Kuala Lumpur* Hotel in Selangor* *Please specify hotel.
Return Date:
Return Time:


DRIVING LICENSE DETAILS
Driving License No.:		Country of Issue:
Expiry Date:

OTHER INFORMATION
Nationality:		Email*:
Country of Residence:		Alternative Email:
Address:		Phone:	Country/Area Code/Number
		Mobile Phone:
		Fax Number:
Other Requirements:	Please Specify

METHOD OF PAYMENT
Cash:
Credit Card:	(We will request payment upon confirmation of rental)