Tahiti TravelNet
6535 Wilshire Blvd., Suite 225
Los Angeles, CA 90048
1-800-747-9997        323-655-2181     FAX: 323-655-2649
yves@tahiti-explorer.com

PHONE RENTAL AGREEMENT - Print and Fax (phone will be Fedex'd to your address 3 days prior to departure)
Bill To: Ship To: (leave blank if same as Bill To)
Name:_______________________________________________   Name:_______________________________________________ 
Company:____________________________________________ Company:____________________________________________
Address:_____________________________________________  Address:_____________________________________________ 
City: ____________________________________ City: ____________________________________
State:_______________Zip Code:_____________ State:_______________Zip Code:_____________


Email :_________________________________ 

Business Phone:_________________________________ 

 Home Phone: __________________________________
Contact Name: ___________________________________   Cell Phone: _______________________________________
Rental Information
Date of Delivery:__________________            Depart Date: __________________       Date of Return:__________________   
Islands:____________________________________________________________       Did you book with TahitiTravel?:_________
Billing / Payment Information (Please select card of use):    
 NO  AMEX      ____ MC      ____ VISA         
Cardholder's Name:___________________________________________________________________
Credit Card Number:__________________________________________________  Exp._____________  CV#._______ (3/4 digit code)
Credit Card Billing Address (if different from above):___________________________________________________________
City:__________________________________ State:______________ Zip Code:_________________

Statement of Authorization

I hereby authorize TravelNet to bill all rental charges to my credit card provided on this agreement form.
Minimum cell phone rental charge includes 1 week rental ($69) plus Fedex delivery/return as per Fedex rates.  Extra rental days will be
billed at $10.00 per day
I understand that this rental fee is for a phone that includes the subscription to the local network operator, and for shipping of phone.
I understand it does not include any call time, and that call time will be purchased by me locally at the applicable local rates.

I understand that TravelNet makes no warranty, express or implied, as to call quality or availability of each islands cellular network. 
The quality of the cellular signal will vary depending on location.  TravelNet is not liable for direct or consequential damages resulting
from equipment failure (phone is ckecked prior to shipping), or any failure of the service provider.              

I agree that I am fully responsible for any damage, loss, or theft of the phone and equipment and I agree that a charge of $240 will be
applied to the card above for any loss or damage to the phone and/or accessories. Phone is fully checked prior to shipping.
Also, I am fully responsible for all call charges.  Any unused minutes remaining will be lost.  No refund or rebate is available.

By signing this agreement, I acknowledge that I have read and understood this statement of authorization and authorize TravelNet

to charge my credit card for any and all charges incurred under the terms of this agreement.  

Cardholder's Signature:_______________________________________________Date:__________________________

Please fax order form to: 323-655-2649

Do you wish to be contacted after we receive this form?  Yes ____    No ____