Blue Travel, Inc. - RESERVATION FORM - Europcar Vehicle Rental Please fax to USA Toll Free: 1-877-605-6888 or Australia: +61-2-9475-4888 Germany: +49-69-3809-9888 . CUSTOMER ADDRESS: (please print) : ___ Mr. ___ Mrs. . Last Name: _____________________________________________________ . First Name: _____________________________________________________ . Street: _____________________________________________________ . City: _____________________________________________________ . State, ZIP: _____________________________________________________ . Country: _____________________________________________________ . Tel +Area Code: _____________________________________________________ . Fax +Area Code: _____________________________________________________ . E-Mail: _____________________________________________________ . PAYMENT: Card Type: ____ MasterCard ____ VISA ____ Diners Club . ____ American Express ______________ ID . Card Holder: _____________________________________________________ . Full Cardnumber: _____________________________________________________ . Expiration Date: ____/____ . RESERVATION: This is a legally binding reservation request and I authorize Blue Travel to disclose my personal information to Welcome Tourism Services. I give permission for Welcome Tourism Services to charge my credit card accordingly with the appropriate hire costs. I acknowledge that I am the authorized card holder of this account, have read the Terms and Conditions and agree to abide by them. . . RESERVATION: _x_ Super Cover . Vehicle Type: __________________________________________________ . No. of Passengers: ___ . Pickup Location: _____________________ Date: _________________ . Drop off Location: _____________________ Date: _________________ . . ADDITIONAL COMMENTS: . . . . . . . . . ____________________________________ ___________________________________ City and Date Signature