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I would like to hire a Rescue Beacon from you, here are my details and requirements. PLEASE NOTE that Google Chrome Web Browser only works intermittently on this site. If possible please use Safari, IE7 or Firefox or phone Mike 021 0294 1521
Number of Beacons required:
First Name:
Last Name:
Please state your home address - must be a physical address, not a PO Box number
Street No:
Street Name:
Suburb:
Town / City:
Post Code:
Country:
Landline Ph Please inc area code:
Mobile No Pls include network code:
Your Email address:
NZ Drivers Lic Nº:
Passport No
(Only if not NZ Citizen):
Passport place of issue:
Delivery Address (Not a P.O. Box)
Company Name (if applicable):
Deliver to First Name:
Deliver to Last Name:
Delivery Street No:
Delivery Street Name:
Delivery Suburb:
Delivery Town:
Delivery Post Code:
Delivery Comments:
Period of Hire - (NB your area may not have CourierPost deliveries at weekends)
Hire Start Date:
Hire Return Date:
Number of people on your trip:
Emergency Contact / Next of Kin
(These people should have your trip info including, vehicle location, duration of trip, and equipment you are carrying)
Contact 1: Name:
Contact 1: Phone (Primary):
Contact 1: Phone (Secondary):
Contact 1: Street Nº:
Contact 1: Street Name:
Contact 1: Suburb:
Contact 1: Town:
Contact 1: Post Code:
Contact 2: Name:
Contact 2: Phone (Primary):
Contact 2: Phone (Secondary):
Contact 2: Street Nº:
Contact 2: Street Name:
Contact 2: Suburb:
Contact 2: Town:
Contact 2: Post Code:
How did you hear about us?:
The 3 fields below must be completed, for your hire request to be sent to us.
Terms and Conditions *:I accept the terms and conditions
Your Email For Booking Confirmation*:
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