Wizard Profile Application

Please fill appilcation form and submit.



Application form


Avis Wizard Profile	New application Additions to an existing Avis Wizard Profile.


Existing Avis Wizard Profile no.:



Information


First and last names


Company


Tax Identification Number (NIP)


Street and number


Postal code and Town


Country


Contact phone


Driving licensee number


Country of issue:


Day of birth


Place of birth


If an Avis Worldwide Discount Number (AWD no.) has been issued to your company, please state here the number below:



Optional Insurance


Collision Damage Waiver (CDW)	Yes No


Personal Accident Insurance (PAI)	Yes No


Theft Protection (TP)	Yes No


Personal Effects Protection (PEP) - only in USA	Yes No


Additional Liability Insurance (ALI)	Yes No



Credit Card Information


The Avis Wizard Profile may be used in connection with various credit cards. Please tick the box for the charge card you wish to use:	EuroCard/Access/Mastercard Visa Diners Club American Express



Frequent traveller: If you are member of a "Frequent Traveller" club and this entitled to points in connection with Avis car rental, please fill in (only one number):


Airline/Hotel


Frequent Traveller no.: