PlanetFone - Domestic Cellphone Rentals

PLANETFONE DOMESTIC RENTALS

HAWAII, THE US VIRGIN ISLANDS, PUERTO RICO, COSTA RICA, ARUBA, THE BAHAMAS AND THE CAYMAN ISLANDS AMONG OTHERS.

1-888-988-4777

Domestic USA Rental Application

* Denotes Required fields

First Name*		Last Name*
Company
Shipping Address
Shipping Address*

City*		This address should match the billing address for the credit card you will be using for the rental
State/Province
Zip Code *
Country:*
Phone*		Fax
Email*

For your own protection, if your Shipping Address and Billing Address do not match your order may be placed on hold until we can validate your information.

Billing address*

Please enter address as it appears on your credit card statement.

Registered Name

If different than application name

Hotel or Residence
Address*

City*

State*

Zip*

Phone*

Fax

Phone Delivery Date*	Activation Date*	Return Date*
Please enter all dates in the mm/dd/yyyy format or use the calendar tool

Select Shipping Method

Must be submitted before 4:00 p.m. Pacific standard time for Overnight Shipping.

Please check this box if the phone will be returned from outside the continental United States.

If you are going on a cruise please check this box

Quantity of phones ordered *

Special instructions or notes.

How did you hear about PlanetFone?

Referred by a friend	Radio
Used service before	Search Engine
Newspaper	Magazine
AAA	Agent Referral

Travel Agent Information
Agency
Agent
Agency Address
Phone

I authorize PLANETFONE to use the following card to pay for my cellular phone rentals and fees

Master Card VISA Card American Express Discover

Credit Card Number *

(1234)

(5678)

(9012)

(3456)

Exp. Month*	Exp. Year*
Ex. (Feb = 02) (2 Digit month)	Ex.(2006 = 06) (2 Digit Year)
For security purposes please include 3 or 4 digit security code		3 Digit Code

Name on Card*

	Available Insurance*	Deductible
	$2.99 - per day	No deductible
	$1.99 - per day	$75.00 deductible
The replacement cost of the phone without insurance is $300.00 U.S. *Insurance will automatically default to $2.99 unless the other option is checked..

$.99 - No Deductible No Charge - $75.00 Deductible

Credit Card Authorization

PlanetFone will take an authorization from your credit card. This is not a deposit, but only a hold on the funds, lasting between 24-72 hours depending on the issuing bank. PlanetFone maintains the right to charge and reauthorize your credit card each time your account balance reaches the authorization amount of $300.00.

Please Note: All prices are in U.S. Dollars. Applicable U.S., State, and foreign taxes, including Value Added Taxes in certain countries, are not included, are additional; and will be added. Rates are subject to change without notice.

Please Note: A $75.00 cancellation fee will be charged if a phone order is cancelled after we ship.

Statement of Authorization
I hereby authorize PLANETFONE to bill all cellular phone rental charges and fees to my current credit card as directed above. If approved, I understand that any charges billed to my designated credit card will be subject to other charges that appear on the account in accordance with the terms and conditions governing the account. Each time I rent a cellular phone, it will be subject to a credit card authorization before my reservation is confirmed and the cellular phone kit is delivered. If I cancel my order, I agree to pay any incurred costs and cancellation fees. If my card status changes, or if my card is lost or stolen, I agree to notify PLANETFONE and the appropriate credit card company immediately. If I elect to terminate this credit card authorization to bill my account, I will notify PLANETFONE and the appropriate credit card Company.

Indicate here as having read, understood, and agree to the Terms & Conditions
Print Name:*

* Required Field

E-mail PlanetFone: support@planetfone.com
Calling from outside the United States: +1 626-792-9978
Calling within the United States Toll Free: 1-888-988-4777