Name:                          

Address:                       

City:                             State:

Zip:                             

Phone:                         

Cell Phone:                  

Email:                          

Drivers License:             (fax or send copy)

Birth Date:                         

Occupation:                  

Place of Employment:    

Employment Phone#:     

Number of People:        

Names of People:          

Arrival Date & Time:     

Departure Date & Time:

Property Rental Choice:

Where did you hear about us?

I understand that by submitting a down-payment to hold my rental, that I have committed to that rental date, subject to verification and approval of application, and that I will lose my down-payment, as noted in the web page, if I fail to carry through with my rental. I ALSO AUTHORIZE COLVIN RENTALS TO CHARGE $_______ TO THE FOLLOWING CREDIT CARD, AS A RENTAL DOWN PAYMENT ON THE DAY OF BOOKING, AND $_______ FOR THE RENTAL BALANCE ON THE DAY OF THE RENTAL.

(SIGNATURE REQUIRED--may be evidenced by

facsimile)_____________________________________________________________________

VISA OR MASTERCARD:   

CARD NUMBER:             

EXP. DATE:                  

NAME ON CARD:           

WE RESERVE THE RIGHT TO REFUSE SERVICE TO ANYONE.

Please fill out this form, print it and fax to: 318-254-1198. This form cannot be submitted via the Internet.