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Fill in this form , print it out and fax it to: +353 61 404451
From the USA: 011 -353-61-404451

Emerald Alpine Rental Agreement Form
Patrick Street, Limerick, Ireland
Booking Date Holiday start Holiday finish Booking Ref.
Collection PointDrop Off Point your phone No: your Fax No:
Your Email:  
CUSTOMER DETAILS
Customer NameAddressCountry
BICYCLE DETAILS
Model Your height Lady or Gent Frame size Extras
Saracen
Saracen
Saracen
Saracen
PAYMENT DETAILS
Details € Price x Units Total Cost.
Price Per Bike
Delivery Fee
Collection Fee
Pannier Bag
Car Carrier
Total
       
PAYMENT METHOD
Cash ( )CC ( )Vouchers ( )
CREDIT CARD DETAILS
Name
CC No:
Expiry Date
Card Type
Conditions and Insurance:This agreement provides free insurance cover as follows: LOSS OR DAMAGE SUBJECT TO THE FOLLOWING EXCLUSIONS - 1. Theft of accessories unless the bicycle is stolen - 2. Loss of use, depreciatrion, wear & tear or breakdown - 3. Damage to tyres by road punctures, cuts or busts - 4. The first €100.00 of each and every claim for accidential damage or total loss - 5. Theft of bicycle unless it is locked by a suitable locking device - 6. Loss or damage whilst the bicycle is being used in racing - 7. The insured must wear a helmet - 8. All Rental fees, extra charges, loss or damages will be charged to your credit card - 9. All bookings can be cancelled up to One month before start date at no charge, after that you will be charged full fee.
The Lessor shall not be liable to the customer for any injury, damage, loss, delay or irregularity whatsoever arising by reason of any defects in the cycle or by the acts or defaults of any company or person carrying out the arrangements proceeding from this rental agreemen. I AGREE TO THE CONDITIONS AND I DECLARE THAT I AM IN GOOD HEALTH AND HAVE NO PHYSICAL DEFECT OR INFIRMITY

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