Mail to:  P.O. BOX 1049 FLORA VISTA, NM 87415 or Fax to : 505-334-1475   Ph 505-334-1800

Today's Date _______________________  Name ________________________________________________

Address_________________________________________________________________________________

City ____________________________________State ______________________ Zip Code______________

Phone # _________________________ Cell # _____________________Work # _______________________

Employer _______________________________________ Driver License # ___________________________

Requested Rental Date _______________________ thru NOON on ________________________________

 Return hour is by 12:00 noon following the last rental night. NO EXCEPTIONS !!!!!!!

 Is this for     DELIVERY   or   PICK UP ?           Delivery / Pick Up Time ______________________________________

( You must schedule an exact time & be on time for the pick up or delivery. If you are late, a fee will be imposed)

Type of Unit Requested ( please circle one)   TRAVEL TRAILER        TOY HAULER      MOTORHOME

Please fill in NAME or NUMBER  if you are requesting a specific Unit   ____________________________

Destination __________________________ Estimated Miles __________ # of People in Party ____________

Bringing a pet ?  YES   NO        Children under age 5 ?    YES    NO     Do you need a ball mount ?   YES    NO

Your Insurance Carrier _______________________________ Agents Name _______________________________

Agents Phone Number ____________________________ Policy Number _________________________________

(If you are towing this unit you are required to list your insurance company & inform them of your intent to tow a rented RV. )

 A RESERVATION FEE of $ 42.53 ( $40 plus tax ) is required .       ( We accept VISA , MASTERCARD , DISCOVER )

Reservation Deposit Check # _______________________or Money Order # ________________________________________

Credit Card # ______________________________________________ Exp. Date _________________ CID # _____________

Your signature on this form permits us to process a credit card voucher in your name for all charges due us under this agreement.

I agree my credit card information is held until all monies due us are paid in full.

Questions / Special instructions /  Delivery Directions /  Delivery Contact Person & Phone #/ Map : ______________________________________________________________________________________________________

______________________________________________________________________________________________________

Please return this form with  your deposit and the following information about your towing vehicle. ( A copy of your drivers license

and a copy of CURRENT Insurance for the towing vehicle will be required at the time of pick up )

Year __________Make ____________Model __________ Color______License Plate # ____________________ State _______

If we are unable to park the RV in your requested location or refusal of the RV for any reason upon delivery, you are still obligated to pay the reserved nights of the rental agreement in full. If you cancel your reservation for any reason you will be liable for the cancellation fee of $42.53.  If you need to return the unit earlier than your scheduled return date, you may do so, but your rental fees will not be refunded. Please call to make sure some one is available to check you back in.

I am of legal age and I have reviewed all of the information on this form and the website and I understand the terms and conditions of the rental procedures. I have reviewed this form in its entirety and find it correct, current and agreeable to me.

Permission to Sign form :       ____  ATTACHED   _____ NOT APPLICABLE

  Signed _______________________________ Date _____________Daytime Phone #___________________