Planetfone Rental Application

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PlanetFone Rental Application
Fill out form and submit, or print form and fax

Toll free fax: 1-888-388-4800

AAA Members click here to receive 10% off Rental

Citibank Members Click here to Order

First Name*	Last Name*
Company
Shipping Address*
City*	State*	Zip*
Phone*	Fax
Email*

For your own protection, if your Shipping Address and Billing Address do not match your order may be placed on hold until we can validate your information.
Billing Address*	Please enter address as it appears on your credit card statement.
City*		State*		Zip*
Phone			Fax

Phone Delivery Date*
/ /

Activation Date*
/ /

Return Date*
/ /

Select Shipping Method

Must be submitted before 4:00 p.m. Pacific standard time for Overnight Shipping. Orders Placed after 4:00 PM (PST) will not process or ship until next business day

Orders placed Saturday/Sunday will not ship until Monday; earliest delivery Tuesday

If you are going on a cruise please check this box

Check here if you want the package to be left without your signature. If you mark "Yes", then you are accepting full responsibility for the phone and all calls made from the phone.

Optional - One Year Executive Service Plan (call for rates)

	Optional - Check for Data Cord delivery. (Data cord is used to connect laptop to GSM phone for Email and FAX capability)
....Optional - Check here for your 800 Toll free Number what's this
Quantity of phones ordered*

Please list all of the countries you will be visiting
Country 1	Country 2	Country 3

Country 4	Country 5	Country 6

Country 7	Country 8	Country 9

Country 10

Special instructions or notes.

How did you hear about PlanetFone?

Referred by a friend	Radio
Used service before	Search Engine
Newspaper	Magazine
AAA	Agent Referral

Agent Information
Agency
Agent
Agency Address
Phone

Enter Promotional Code:

Search engine used

Keyword searched

Press (ctrl + click) to select more than one option

I authorize PLANETFONE to use the following card to pay for my cellular phone rentals and fees

Master Card VISA Card American Express Discover

Name on Card*

Credit Card Number *

Exp. Month*

Exp. Year*

(1234)

(5678)

(9012)

(3456)

Ex. (Feb = 02)
(2 Digit Year)

Ex.(2009 = 09)
(2 Digit Year)

For security purposes, please include the 3 or 4 digit security code (found on the back/front of your card)

3/4 Digit Code*

	Available Insurance*	Deductible
	$1.99 - per day	No deductible
	$0.99 - per day	$75.00 deductible
The replacement cost of the phone without insurance is $300.00 U.S. *Insurance will automatically default to $1.99 unless another option is checked.

$1.99 - No Deductible $0.99 - $75.00 Deductible No Insurance - $300 for lost phone

Please Note: There will be a $300.00 authorization taken from your designated credit card.

Please Note: All prices are in U.S. Dollars. Applicable U.S., State, and foreign taxes, including Value Added Taxes in certain countries, are not included, are additional; and will be added. Rates are subject to change without notice.

Please Note: A $75.00 cancellation fee will be charged if a phone order is cancelled after we ship.

Statement of Authorization
I hereby authorize PLANETFONE to bill all cellular phone rental charges and fees to my current credit card as directed above. If approved, I understand that any charges billed to my designated credit card will be subject to other charges that appear on the account in accordance with the terms and conditions governing the account. Each time I rent a cellular phone, it will be subject to a credit card authorization before my reservation is confirmed and the cellular phone kit is delivered. If I cancel my order, I agree to pay any incurred costs and cancellation fees. If my card status changes, or if my card is lost or stolen, I agree to notify PLANETFONE and the appropriate credit card company immediately. If I elect to terminate this credit card authorization to bill my account, I will notify PLANETFONE and the appropriate credit card Company.

Indicate here as having read, understood, and agree to the Terms & Conditions*
Print Name:*	Today's Date:* / /

* Required Field

Toll Free: (888) 988-4777
Fax: (888) 388-4800
Email: PlanetFone

PlanetFone Terms and Conditions