PlanetFone Rental Application
Fill form and submit, or print form and fax.

AAA Members click here to receive 10% off Rental

Citibank Members Click here to Order

First Name* Last Name*
Company
Shipping Address*
City* State* Zip*
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.
City* State* Zip*
Phone Fax

Phone Delivery Date*
/ / 		Activation Date*
/ / 		Return Date*
/ /
    Select Shipping Method

 Must be submitted before 4:00 p.m. Pacific standard time for Overnight Shipping. Orders Placed after 4:00 PM (PST) will not process or ship until next business day
Orders placed Saturday/Sunday will not ship until Monday; earliest delivery Tuesday
If you are going on a cruise please check this box
Check here if you want the package to be left without your signature. If you mark "Yes", then you are accepting full responsibility for the phone and all calls made from the phone.
Optional - One Year Executive Service Plan (call for rates)
Optional - Check for Data Cord delivery.
(Data cord is used to connect laptop to GSM phone for Email and FAX capability)
....Optional - Check here for your 800 Toll free Number what's this
  Quantity of phones ordered*     
Please list all of the countries you will be visiting
Country 1 Country 2 Country 3
Country 4 Country 5 Country 6
Country 7 Country 8 Country 9
Country 10    
   
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
Agent Information
Agency 
Agent 
Agency 
Address 
Phone 
Enter Promotional Code:

Search engine used

Keyword searched     

Press (ctrl + click) to select more than one option
 
I authorize PLANETFONE to use the following card to pay for my cellular phone rentals and fees
 Master Card     VISA Card    American Express     Discover
Name on Card*
    
Credit Card Number *
Exp. Month*
 Exp. Year*
(1234)
(5678)
(9012)
(3456)
Ex. (Feb = 02)
(2 Digit Year)
Ex.(2006 = 06)
(2 Digit Year)
For security purposes, please include the 3 or 4 digit security code (found on the back/front of your card) 
3/4  Digit Code*
 
 
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 another option is checked.
 $2.99 - No Deductible $1.99 - $75.00 Deductible No Insurance - $300 for lost phone
 
Please Note: There will be a $300.00 authorization taken from your designated credit card.
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 cancelle