Please provide the following information

For corporate hiring, please click here
Full Name *
 (as per NRIC/passport)
Current  Address *
State
Postal Code
Country
Telephone No.
Country Code
 

Area Code
 

 Phone number
Email Address
NRIC / Passport Number *
Nationality
Issuing Country
Date of Birth    (dd/mm/yyy)
Place of Birth
Driving License Number *
Driving License Expiry Date *   (dd/mm/yyyy)



Please fill in the following for corporate rental

Occupation
Name of Business /Employer
Business Address
Business State
Business Postal Code
Business Country
Business Telephone No.
Country Code

Area Code

Phone number


Select the options that you prefer



- For multiple selection, please press "Ctrl" key and select

Collision Damage Waiver (CDW)
Yes  No		 Personal Accident Insurance (PAI)
Yes  No

Mode of Payment
American Express Diners Club JCB VISA Mastercard

Duration of Hire (dd/mm/yyyy)
From    To   


Place of Pickup (Airport or ORIX Office only, or call our offices to make arrangements)


Flight Number (Arrival)
  
Arrival Time
Place of Drop-Off
Flight Number (Departure)
  		 Departure Time
 

Comments

 

* The above is just a request for reservation and is not binding until you have obtained ORIX Car
   Rentals confirmation.
* Rental Rates are subject to 5 % government service tax.

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