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					VW Campervan Hire – Booking Form                     Dorset Dubbers Limited
                                                                Retro Camper Hire
Chosen vehicle: ……………………………………………………………………
First Driver’s Name: …………………………………………………………………….
Address: …………………………………………………………………………………
…………….……………………………………………Postcode: ……………………..
Tel (home): ………………(mobile): …………………Email: ………………………....
Driver(s)
Name: ……………………… Driving Licence No: …………………………………….
Name: ……………………… Driving Licence No: …………………………………….


Names of other passengers: ……………….……………………………………………..
Number of adults: ……. Number of children: ……. Age of children: ………………..


Where did you hear about Dorset Dubbers Limited? Advert/Article/Search Engine/Word of Mouth/Other
Please specify where you saw us if advertising/article or which Search Engine?
……………………………………………………………………………………………
Hire period from 14.30 on (date): …..………… to 10am on (date): ……..…………(the “Hire Period”)


 Equipment/ Extras                                        Price          Please indicate amount
 Sleeping Bag (Adult) which you keep after the hire       £25
 Sleeping Bag (Child) which you keep after the hire       £15
 Pets                                                     £20
 Free-standing Awning                                     No charge
 Camp beds                                                No charge
 Cycle rack                                               £10
 Child Cab Bunk                                           £10
 Collection/ Return Hinton Admiral Station                No charge
 Collection/ Return Bournemouth Airport / Local train     £25 each way
 Stations / Coach Station
 I would like to park my car outside your premises        No charge      Yes/ No
 Collision Damage Waiver




                                                      1
Cost of Hire: ……………………………..
Cost of Equipment/Extras: ……………………………..
Total Payable: (the “Hire Charge”) ………………………….....
Less Booking Deposit: ……………………………..
Balance Due: ……………………………..


I understand that the Booking Deposit of £150 is non-refundable and I agree to the Terms and Conditions of
Booking and Hire:
Signed:    ………………………………………… Date: ………………………..
Print Name: ………………………………………




                                                2
Insurance Booking Form – a form to be completed by the First Driver

Please note that Dorset Dubbers Limited (“DD”) cannot release the campervans without sight of your original
Driving Licence (Photo ID card & Paper Licence) and an original
utility bill, which is no more than 3 months old. Please remember to bring these with you. Please note DD
doses not except photocopies.

Name: ……………………………. Date of Birth: ……………………………...........
Driving Licence Number: ……………………………………………………………..
Occupation: ………………………… Employer’s Name: ……………………………
Date Driving Test Passed: ………………. Licence issued in which country?: ………

1. Motoring Accidents in the last 3 years? Yes/No                                     How many years ago? ……......

2. Any physical or mental conditions which may interfere with your ability to drive?
These could be stroke/deafness/heart condition/diabetes/loss of limb/loss of sight
in an eye/epilepsy/blackouts: Yes/No
If so, please list: …………………………………………………………………..
…………………………………………………………………………………….

3. Have you ever been refused motor insurance? Yes/No
If so, please name the company: ………………………………………………….

4. Have you ever been convicted of any motoring offences? Yes/No
If so, please list the offence code and date (as indicated on your Driving Licence)
.................................................................................................................................
…………………………………………………………………………………….
Please note that answers to these questions may not prohibit you from hiring
a vehicle but for insurance purposes you must declare ANY endorsements,
motoring accidents, or physical or mental conditions.

DD is more than willing to pay the insurance on your vehicle hire for the first named
driver, however if our insurance company adds a loading to the insurance due to an
additional driver or responses to the above questions, DD will pass this additional
cost onto the hirer. The cost of an additional driver is usually around £3.50 per day.

The insurance excess payable by you is £500. If you would like to reduce this please
indicate which option you would like to take up:

 I would like to reduce the excess to £250 at a cost of £5.87 per day (inc vat)
 I would like to reduce the excess to zero at a cost of £11.75 per day (inc vat)
 I would like to keep the excess at £500 at no cost
These insurance options relate to the vehicle not to each driver.
                                                   3
Insurance Booking Form – a form to be completed by Additional Drivers

Please note that Dorset Dubbers Limited (“DD”) cannot release the vehicle without sight of your original
Driving Licence (Photo ID card & Paper Licence) and an original
utility bill, which is no more than 3 months old. Please remember to bring these with you. Please note DD
doses not except photocopies.

Name: ……………………………. Date of Birth: ……………………………..........
Address if different from 1st Driver: …………………………………………………..
………………………………………………………………………………………….
Driving Licence Number: ……………………………………………………………..
Occupation: ………………………… Employer’s Name: ……………………………
Date Driving Test Passed: ……………….Licence issued in which country?: ………..


1. Motoring Accidents in the last 3 years? Yes/No                                     How many years ago? …….......


2. Any physical or mental conditions which may interfere with your ability to drive?
These could be stroke/deafness/heart condition/diabetes/loss of limb/loss of sight
in an eye/epilepsy/blackouts: Yes/No
If so, please list: …………………………………………………………………..
…………………………………………………………………………………….


3. Have you ever been refused motor insurance? Yes/No
If so, please name the company: ………………………………………………….


4. Have you ever been convicted of any motoring offences? Yes/No
If so, please list the offence code and date (as indicated on your Driving Licence)
.................................................................................................................................
…………………………………………………………………………………….
Please note that answers to these questions may not prohibit you from hiring a vehicle but for
insurance purposes you must declare ANY endorsements, motoring accidents, or physical or
mental conditions.

DD is more than willing to pay the insurance on your vehicle hire for the first named
driver, however if our insurance company adds a loading to the insurance due to an
additional driver or responses to the above questions, DD will pass this additional
cost onto the hirer.




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posted:7/18/2011
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