APPLICATION FORM
Suzuki UK110 Address Scooter - $115 per week - $250 Security Deposit
Rental Period
*
One Month
Three Months
Four or more months
Date
-
Day
-
Month
Year
Date
Full Name
*
First Name
Last Name
Address
*
Street Address and Suburb
Street Address Line 2
Suburb
State
PostCode
Email
*
Mobile Number
*
Date of Birth
*
-
Day
-
Month
Year
Motorbike License Number
*
Is your license in English?
*
Yes
No
If not in English, do you have a certified translation?
*
Yes
No
Not applicable
Insurance Questions
Age you got your first license?
*
Gender
*
Male
Female
Storage Location
*
Please Select
Garage
Carport/Undercover
Driveway/Property
On Street
Accidents in last 3 years?
Please Select
0
1
2
3
4
5+
Theft claims in the last 3 years?
Please Select
0
1
2
3
4
5+
License Suspensions in last 2 years
*
YES
NO
How did you hear about us?
*
Please Select
Website
Facebook
Marketplace
Friend
Scooter Lease Pty Ltd
Yeerongpilly, Brisbane
rent @ scooterlease.com.au
We will contact you via email.
Please check your email for next step...
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