Untitled Document
Broker Vehicle Hire Application

Please complete the form below to reserve a vehicle for your client.
Note : This is an car hire application only and your credit card details will be confirmed telephonically.

If you have any questions regarding this application then please contact us on (039) 316 8342 or
email Joy at jfranke@motolink.co.za.

Click on the Print Button if you want to print the application form and fax to us.


Claims Handler
Date *
Authorised by *
Telephone Number *
Email Address (Application Copy sent here) *
Insured Details
Insurer *
Claim Number *
Insured Name *
Driver *
Contact Number *
Type of Incident *
Rental Detail
Car Group *
Date Hired From *
Total Days Required *
Max. Days Allowed *
Remarks
* - Required Info
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