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					                                              GENERAL INFORMATION
(*) Have you used the services of Dollar Thrifty Russia before? (tick)
    ___Yes          ___No
(*) How do you know about Dollar Thrifty Russia? (filled if you first use the services of Dollar Thrifty Car Rental)
___Friend’s recommendations                      _________________
___Internet             (name of web-site)       _________________
___Dealer Centre                (indicate)         ________________
___Outdoor advertisement        (indicate)        _________________
___Advertisement in mass media (indicate)          ________________
___Advertisement on radio        (indicate)        _________________
___Guides                       (indicate)          _________________
___Advertisement on vehicles     (indicate)         ________________
___Other                        (indicate)          _________________
(*) Would you like to receive information letters and mailing from Dollar Thrifty Russia?
    By e-mail ___Yes                     ___No
    By post   ___occupant mailing
              ___registration mailing


                                    YOUR PERSONAL INFORAMTION
     (*)Last Name                             _________________
     (*)First Name                            _________________
     (*)Second Name                           _________________
     (*)Gender      ___М F___
     (*)Date of birth (dd/mm/yyyy)            _________________

        (*) Adress

     Place of residence registration (including postal code) _________________

     Place of occupation (including postal code) _________________
     ___agrees with place of residence registration


        (*) Your Contacts

        Phone number (including city/town code)              home _________________
         (underline the preferred one)                        work _________________
                                                              mobile _________________

        Email (Internet mail) _________________


* required




                                                                                                                  "Raiden-Rent, ltd"
                                                                                                                   125445, Moscow,
                                                                                                 Leningradskoe shosse, build.63-Б
                                                                                           Тel.: (495) 788 6888, fax: (495) 974-1908
                                                                                                                  www.dollarrent.ru
   Passport and Other Identification Documents

           (*) Passport         series           _________________
                                  number          _________________
                                  who and when gave (dd/mm/yy)
           ____________________________________________________

           Foreign passport     series          _________________
                                 number           _________________
                                 who and when gave
           _________________________________________________

        (*)Driver’s license          series       _________________
                                      number      _________________
                                                  who and when gave (dd/mm/yy)
           _________________________________________________________________
                                 expiration date (dd/mm/yy) _________________

   (*) Information About Your Own Vehicle
              mark _________________
              model _________________
              license plate _________________
              model year (yyyy) _________________
              form of ownership:
                 attorney(tick) ___
                 passport of your own car___


   (*) Information About Your Credit or Debit Card
      Indicate type of your credit or debit card
      Number of Your credit or debit card                 _________________
      Full name of owner (as it is placed on the card)     _________________
      Valid to (mm/yyyy)                              _________________

      Number of Your credit or debit card              _________________
      Full name of owner (as it is placed on the card)     _________________
      Valid to (mm/yyyy)                             _________________
      (filled if you own two cards)

    INFORMATION ABOUT CAR RENTAL PREFERENCES AND TERMS

   (*) Preferred Type of Vehicle (Tick)

    ECMR: HYUNDAI GETZ 1.3 HB___
    ECAR: HYUNDAI GETZ 1.3 AT HB ___
    CCMR: Mitsubishi Lancer 1.6 Sedan___
           Ford Focus 1.6 HB___
           Ford Focus II 1.6 HB ___
    CCAR: Mitsubishi Lancer 1.6 AT Sedan___
    CWМR: Mitsubishi Lancer 1.6 SW___
    ICMR: Mazda 6 1.8. Sedan___
           Ford Mondeo 1.8 Sedan___
           Ford Mondeo 2.0 Sedan ___
     FCAR: Audi A4 2.0 AT Sedan___
     PCAR: Audi A6 2.4 AT Sedan___




                                                                                             "Raiden-Rent, ltd"
                                                                                              125445, Moscow,
                                                                            Leningradskoe shosse, build.63-Б
                                                                      Тel.: (495) 788 6888, fax: (495) 974-1908
                                                                                             www.dollarrent.ru
   (*) Preferred Pick-up Location (choose)
            Moscow North        _________________
            Moscow South       _________________
            Moscow West       _________________
            Moscow East          _________________
            Airports: ___Sheremetievo       ___Domodedovo
                        ___Vnukovo                      ___Bykovo


   (*) Preferred Form of Payment

 ___Cash Payment

 ___Non-cash Payment

 ___Money Transfer

 ___Credit or Debit card

 ___Cheque Card


   (*) Preferred rates

 Limit
    ___ limit mileage                 ___unlimited mileage
        (200 km per day)                (without any limits)


 Personal Limit Responsibility
    ___CDW (car damage due to actions of third part)
    ___TP (car hijacking)

 Unconditional Franchise (If insurance case (car damage or hijacking) and Client has correctly and timely executed all the
    necessary documents on any insurance case, his/her responsibility before Dollar Thrifty Russia within franchise account of
    money) (required cash payment).
    ECMR, ECAR – 100$; CCMR, CWМR, ICMR, CCAR – 500$; FCAR, PCAR – 1000$


 Form of Franchise (tick)
    ___Credit or Debit card
    ___Cash Payment
    ___Non-cash Payment
    ___Money Transfer
    ___Cheque Card

   Form of depositing
    ___Credit or Debit card
    ___Cash Payment
    ___Non-cash Payment
    ___Money Transfer
    ___Cheque Card


   (*)Preffered area

    ___Moscow и Moscow Region
    ___Regions of The Russian Federation
    ___Other     __________________

                                                                                                                 "Raiden-Rent, ltd"
                                                                                                                  125445, Moscow,
                                                                                                Leningradskoe shosse, build.63-Б
                                                                                          Тel.: (495) 788 6888, fax: (495) 974-1908
                                                                                                                 www.dollarrent.ru
  ___________________________________________________________________________


        I, _________________, confirm, that all above-placed information is correct at the moment of filling the
Questionnaire of Dollar Thrifty BONUS Member.
        Dollar Thrifty Russia (Raiden-Rent, ltd) represented by__________________thank you for above-placed
information and ensure its confidentiality.



Date of filling the questionnaire __________________

Name of employee          __________________




                                                                                                      "Raiden-Rent, ltd"
                                                                                                       125445, Moscow,
                                                                                     Leningradskoe shosse, build.63-Б
                                                                               Тel.: (495) 788 6888, fax: (495) 974-1908
                                                                                                      www.dollarrent.ru

				
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