crash pad

RENT A
CRASH PAD
Duration (Day)
Price (euros)
1
8
2
16
3
21
4
28
5
35
6
42
7
46
If you already complete a first visit record, please complete only red points
□ M □ Mrs □ Miss
.LAST NAME ……………………………………………………….
.DATE OF BIRTH ………/………/………………
.FIRST NAME………………………………………………………………………………..
AGE …………years
ZIP CODE …………………………………………
CITY…………………………………………………………………………………………
.
COUNTRY ………………………………………………………….
PHONE : …….. …….. …….. …….. ……..
E-MAIL ………………………………………………………………………………..
. Passport or ID Number …………………………………………………………………………………………………….
Cadre réservé à l’équipe Karma
Crash pad :
Double Air Bag (130x100cm) - BEAL
Big Air Bag (180x100cm) – BEAL
□
□
Deposit(*) :
Quantity : ……
Cash
Quantity : …..
Check
Duration(**) : ……………………………… day(s)
Passport or ID
□
□
□
I pledge to take care of the equipment
Signature ……………………………………………………………………………… Date ………/………/………………
(*) 150 euros : cashed in case of damage found
(**) One day, 24h, each day started must be paid