Pick Up Only - Clayfield 

(please choose alternative agent for delivery)
Booking Request Form

* Required information

CONTACT DETAILS
First Name*
Last Name*
Street Address*
Address (cont.)
City*
State*
Post Code
Home Phone*
Mobile
E-mail*

DELIVERY DETAILS
Would you prefer pickup or delivery? Pickup Delivery
Same as contact details:* yes no - please fill in below.
First Name
Last Name
Hotel Name
(if applicable)
Street Address
City
State
Post Code
Phone

HIRE DETAILS
Hire Start Date dd/mm/yyyy Delivery/Pickup Time:
Hire End Date dd/mm/yyyy Delivery/Return Time:
No. of Days
Child 1 – Age / Weight:
Child 2 – Age / Weight:
Child 3 – Age / Weight:
Child 4 – Age / Weight:
 

EQUIPMENT REQUIRED
QTY DESCRIPTION
Basic Upright Stroller
Layback Umbrella Fold Stroller
4 Wheel Pram
3 Wheel Jogger
Twin Pram – Tandem (limo style)
Twin Pram – 3 Wheel Jogger (side by side)
Twin Pram – Stroller (side by side)
Twin Pram – Pram with Toddler Seat
Portacot
Fitted Padded Portacot Sheet
Linen / Blanket
Highchair
Carseat – rear facing
Carseat – forward facing
Capsule
Booster
Baby Rocker
Change Table
 
How did you hear about us?*  
 
Hotel/Car Hire Company (Please specify)
Other (Please specify)
 

COMMENTS