AGL Industries - Star Location
Locaux La Bodeguita - Saint-Jean
97133 Saint Barthélemy
ST BARTH SERVICES
THIS FORM MUST BE RETURNED BY MAIL [email protected]
RESERVATION CONFIRMATION
Name: WIESENTHAL Robert Reservation Number: 23LAR04108
Car MINI
Start 19-Nov-2023 12:00
End 25-Nov-2023 12:00
Rental 6 d. x €175.00 €1,050.00
Gas MINI - Fuel deposit refundable €180.00 x 1 €180.00
Total €1,230.00
In order to facilitate your arrival please complete the following informations :
DRIVER'S INFORMATION
35 Hudson Yards, New York, NY
Address ________________________________________ Date of birth _06_ / 22
_ _ / _1966 New York
_ _ _ Place _________________
Zip Code 10001
________________________________________ Phone 646-981-8000
______________________________________
Country United States of America
________________________________________ Email
[email protected] ______________________________________
License 343 288 391
________________________________________ Issued on _ 02
_ / _01_ / _2023 NYS
_ _ _ By ___________________
number
Expiration _06
_ / _22_ / _2028
___
date
CREDIT CARD INFORMATION
Cardholder Name Robert Wiesenthal
_________________________________ Type of card X MASTER __
VISA __ AMEX __
Number _ 373915995502000
___ ____ ____ Expiration date _09_ / _28_
_8480
___
I hereby authorize COOL RENTAL - STAR LOCATION to charge my credit card for the services I have selected
above and for any other related services as requested by me or with my authorization.
Furthermore, I fully understand and agree that the charges specified above are nonrefundable and may not be
charged back at any time in the future.
In case of no return of this voucher signed your reservation will be automatically canceled.
Place Date 10/10/2023
Signature
