Reservation Application

Use the application below to reserve your adventure today! Your application will be processed within 24 hours! Go ahead....Explore America!

Please tell us about yourself:

First Name		Middle	Last Name
Social Security		Date of Birth
Street Address
City		State	Zip Code
Country		Phone
E-mail
Smoker?	Yes No	Income

Please tell us about your employer:

Company Name	Position
Street Address
City	State	Zip Code
Country	Phone
E-mail

Please list 2 Credit References:

1 Company Name	Account
Address	Phone Number
City	State	Zip Code

2 Company Name	Account
Address	Phone Number
City	State	Zip Code

Please enter trip information:

Pick up Date	(mm/dd/yy)	Drop off Date	(mm/dd/yy)	Destination
Pick up Time		Drop off Time		Select Motorhome Categoty
Adults		Children
Do you wish to purchase Collision Protection Coverage?	Yes No
Special Requests

Please provide the following Insurance information:

Insurance Company	Agent
Address	Phone Number
City	State	Zip Code

Please tell us who will be driving the motorhome:

1) Name		Date of Birth		Age
License Number		State		Expiration Date

2) Name		Date of Birth		Age
License Number		State		Expiration Date

3) Name		Date of Birth		Age
License Number		State		Expiration Date

Please provide the following payment information authorizing BATES Motorhome Rental of New Orleans to charge the reservation deposit to your Credit Card:

Credit card
Cardholder name
Card number
Expiration date

By submitting this information, you are authorizing BATES Motorhome Rental of New Orleans to reserve a motorhome for your use during the specified time. You understand that your credit card will be charged $500.00 USD for this reservation. Reservation Deposits are not refundable in the event of a cancellation. All cancellations must be received in writing prior to the scheduled day of departure. Changes or cancellations are subject to a $100.00 minimum processing fee. The balance of the Reservation Deposit may be applied towards a future rental within one year of the cancellation date.