Thank you for choosing Captain Billy's 4WD Hire for all your vehicle requirements. Our friendly and efficient team will confirm your vehicle rental booking within 24 hours. Please do not hesitate to Contact Us if you have any further questions. Once you have completed the form please print and fax to +61 7 4051 4872 or send by mail.

(Bold required)

Your name Your e-mail   Email addresses must be included and correct to receive a response   Quotation Number Q- (if applicable)   Address City Address2 Country State Zip Phone Fax Driver's licence No Country licence issue Date licence issue Expiry date Date of birth

Vehicle Tick Vehicle Type bush ranger bush camper kimberley bush kamper kimberley kamper mariner pack yamaha quad bikes

excess reduction Yes No Please note that excess reduction is completely optional and can be decided upon collection of your vehicle.

optional accessories Booster Seat $25 1 2 3 4 5 6 Personal Kit (Linen & Bedding) $38 per person per rental   Child Seat $25 1 2 3 4 5 6 Tent $75 per rental   High Chair $25 1 2 3 4 5 6 Picnic Table $22 ea per rental   4WD Outback Safety Kit $95 per rental 1 2 3 4 5 6 Outdoor Chair $12 ea per rental   Satellite Phone $17 per day plus call costs.   Fan Heater $10 per rental

Travel Itinerary

Start Location Cairns Finish Location Cairns Pick up Time 8:00am 8:30am 9:00am 9:30am 10:00am 10:30am 11:00am 11:30am 12:00pm 12:30pm 1:00pm 1:30pm 2:00pm 2:30pm 3:00pm 3:30pm 4:00pm 4:30pm 5:00pm Drop off Time 8:00am 8:30am 9:00am 9:30am 10:00am 10:30am 11:00am 11:30am 12:00pm 12:30pm 1:00pm 1:30pm 2:00pm 2:30pm 3:00pm 3:30pm 4:00pm 4:30pm 5:00pm Arrival Flight# Departure Flight#

Please give us an indication in the box below where you will be travelling:

for example: e.g Around the Hobart area e.g Touring all of Tasmania and returning to Hobart

No of Adults 01 02 03 04 05 06 07 08 09 10 No of Children 01 02 03 04 05 06 07 08 09 10

Start Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan (1) Feb (2) Mar (3) Apr (4) May (5) Jun (6) Jul (7) Aug (8) Sep (9) Oct (10) Nov (11) Dec (12) Year 2011 2012 2013 2014 2015 2016 Finish Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan (1) Feb (2) Mar (3) Apr (4) May (5) Jun (6) Jul (7) Aug (8) Sep (9) Oct (10) Nov (11) Dec (12) Year 2011 2012 2013 2014 2015 2016

Comments, Enquiries and Special Requests

Credit card details are required to confirm bookings

Name On Card

Credit Card Type Visa Mastercard

Credit Card Number

Expiry Month / Year Jan (1) Feb (2) Mar (3) Apr (4) May (5) Jun (6) Jul (7) Aug (8) Sep (9) Oct (10) Nov (11) Dec (12) / 2011 2012 2013 2014 2015 2016

I have read and understood Captain Billy's 4WD Hire Terms & Conditions