Rent-A-Relic Car Rental Quote Form

1
Name
First Name
Last Name
2
Your name:
3
What is your age?* This field is required.
Over 25 years old
Over 25 years old
21-24 years old
4
Your email:* This field is required.
5
Your phone number (optional):
6
Pick up date?* This field is required.We are open M-F 8:00 - 5:30; Sat 9:00 - 2:00. We are closed Sundays.
Date
Month
Day
Year
7
Pick up time?* This field is required.
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
5:30 PM
8
Saturday pick up time?* This field is required.
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
9
Return date?* This field is required.
Date
Month
Day
Year
10
Return time?* This field is required.
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
5:30 PM
Other
11
Saturday return time?* This field is required.
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
Other
12
About how many miles do you expect to drive daily?* This field is required.
Less than 100/day
Less than 100/day
100 to 150/day
More than 150/day
13
Questions about Rent-A-Relic?
14
How did you hear about Rent-A-Relic?* This field is required.
-Select an Option-
Returning customer
Referred by a customer or a friend
Internet search
Street sign/live in the neighborhood
Referred by a repair facility
Other
15
Would you like to be added to our email list?* This field is required.
-Select an Option-
Yes
No
Should be Empty: