"Riser Recliner Assessment Appointment"
Scoota Hire Application for Royal Cornwall Show 2012 For office use only Date of application:____________ Please insert, circle or delete as appropriate Driver’s name: Dates and times required: Driver’s home telephone number: Thursday 7th Friday 8th Saturday 9th June June June Driver’s number for contact at the show: am/pm am/pm am/pm Driver’s address: Person making application: Contact number if to be contacted in preference to the driver: Driver information and preferences (insert, circle or delete as appropriate) Height: NB: Left or right hand dominance? Any other concerns/conditions to be aware of : Weight: Preferred scoota collection and drop-off point: Tremorvah Stand or at a gate (please specify) _________Gate. To collect at _______am/pm and return at _____ am/pm Rubrick Our Scootas have a weight-bearing limit of 127kg/20 stone. Drivers whose weight exceeds this will have to make alternative arrangements. The morning booking fee covers from 0830 to 1300 whereas the afternoon fee covers from 1330 to 1700. Returning the scoota late, beyond these times will incur an additional fee. VAT relief Declaration: I am chronically sick or have a disability (as detailed below) and I am eligible for relief from VAT under the VAT act 1994. Note: It is a criminal offence to make a false declaration. Condition: ____________________________ Signature: ___________________ Date: ___________ Number At Cost Whole days £25.00 For office use only: (£30.00 VAT) each Payment received yes / no Date: Half days £17.50 (£21.00 inc Payment by credit card: VAT) each Till receipt number: Total I have read the details above and the conditions of hire overleaf and accept them. Enclosed is the payment for the above detailed hire dates. Signed: ________________________________________ Date: _______________________