Company First Name * Last Name * Address City State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Country Please enter your country United States Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Home Phone * Cell Phone Email Address * Fax How would you like us to contact you? * Phone Email Fax When would you like us to contact you? * Now An Hour A Day A Week or More Departure Date * Return Date * Number of Adults * # of Adults 1 2 3 4 5 6 7 8 Number of Children * # of Children 1 2 3 4 5 6 7 8 Destination * Select a Destination Disney World Daytona 500 Sebring 12 Hrs Florida Keys Daytona Rolex 24 Vinoy - St Pete Sun 'N Fun Gatlinburg, Tenn Ginny Springs Fort Desoto Appalachians - NC College Football Lake Wales Oak Music-Camping Florida Amphitheater/Fairgrounds Ocala National Forest Western USA Other Select a Vehicle * Select a Vehicle Excursion Discovery Thor -Palazzo Acer 30.2 Georgetown 351DSF Hurricane 34J Chateau 23U Chateau 28Z Chateau 30D Vesta 30F Have you driven a similar vehicle in the past? Yes No Have you rented a similar vehicle in the past? Yes No Additional services/amenities Hshhld Bedding/Towels $75 Kitchen Kit $75 Collision Damage Waiver $15 Canvas Camping Chairs $10 Charcoal Grill $39 Dish Satellite Set-Up $50 Dish Daily Service $7.50 Prepay Sewage Disposal $49.90 Towing $200 flat fee Picnic Table $25 Kitchen Kit & One Bedding $130 Convenience Package: $230 Kitchen Kit: Salad and Dinner plates with 3 piece flatware LInen Package Sewage Disposal Outdoor Carpet 2 Camping Chairs Saturday/Sunday Pickup/Return $50 Delivery & Set-Up on Location $200 Bicycle Rack (3 or 4 bike) $25 Coffee Pot $20 Outdoor Rug $25 Would you like to have your vehicle delivered to your destination? (Fees may apply) * Yes No Maybe Special Requests What is your daily Budget? How did you hear about us? Select... Website/Google/Yahoo Lazy Days Radio Friend Repeat Yellow Pages or Superpages Bates Inter'l RV Rntl Drive By Fleet Owner Other Would you like to receive up to date news? Yes No
