Totem Rental Application Form

Complete all fields

Please complete the form below

Incomplete Applications will automatically be ignored

First Name

Last Name

Initials:

ID Number:

Title:

Email Address:

Mobile Phone:

Home Phone:

Fax Number:

Address:

Postal Code:

Employer:

Work Phone:

Rental Start Date and Time:

Rental End Date and Time:

Collection Vehicle Make:

Collection Vehicle Reg:

Licence disc no:

Rental:

Venue Street Address:

Comments:

+27 83 450 9708

14 Carol van der Walt Street Edleen Kempton Park 1619