Wizard Application

This form tells us about you. It allows us to hold your personal details , optional insurances and coverage's and car type in our wizard system , so we can recognize you when you collect your car.

For purposes of signature verification, please print the form using the print button at the end of the page, sign the copy and fax it to: Avis Customer Service (603) 5569 4600, as well as submitting it. A consultant will contact you to complete the process.

Wizard Details

Title *
Other Title *
First Name*
Surname*
E-Mail*
Company Name*
Company Address*
Postal Code *
Home Address*
Postal Code
Country*
Telephone Number (Business)*
Telephone Number (Home)*
Drivers License Number)*
Issuing Country or State *
Identity Number *
Passport Number *
Date of Birth*
City of Birth
Country of Birth

Optional Waivers/Personal Accident Insurance
It is very important to specify your exact requirements. Please check the options below that you require.

Optional Insurance/Coverages)*
Non Waiver Clause ( NWC )
Collision Damage Waiver ( CDW )
Theft Protection ( TP )
Personal Accident Insurance ( PAI )

Car type
Please select a Car group ( i.e. the most frequently rented )

Fleet Group *
Car Group

Frequent traveller
If you hold a Frequent Traveller Membership you may be entitled to points on qualifying Avis rental.
Please indicate the programme you wish these to be credited to (selected one only)

Frequent Traveller
Airline/Hotel
Frequent Traveller Number