StateFleet: Extra Car Online Application Form

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StateFleet
ExtraCar Online Application Form

Please fill in and submit the form below:

Application for Rental of Vehicle
Please Note: The fields marked with an "*" must be completed.
Department:	*
Cost Centre:
Branch:	*
Contact Name for Enquires:	*
Phone No:	*
Fax No:	*
Billing Address:	*
Driver:
Your Reference No:	*
Rental Term
Rental Term requested (no. of days):	*
Description of Vehicle Required
Category: other:	*
Fuel Type:	*
Body Type: other:	*
Preferred Make: (If available) other:	*
Transmission:	*
Accessories (essential): other:
Collection Details
Is the vehicle to be collected from ExtraCar or delivered to a nominated address?	*
Required Date for Delivery: (dd-mm-yyyy)	*
Address for Vehicle Delivery:	*
Required Date for Collection: (dd-mm-yyyy)	*
Authorisation
Delegated Authorisation Officer:	*
Position Title:	*
Email Address:	*
Date of Authorisation: (dd-mm-yyyy)	*
The authorising officer listed in the details above has read and understands the terms and conditions detailed below:*
Terms And Conditions For State Fleet Short Term Lease Vehicles 1. General 1.1 The hirer shall be responsible to ensure that the hire vehicle is not permitted to be: a) Used for any illegal purpose, raced, tow or carry passengers or loads that exceed manufactures specifications or modified in anyway whatsoever. b) Driven by a person or persons while under the influence of drugs or alcohol or have blood alcohol content that exceeds the legal limit of the state or territory in which the vehicle is driven. c) Driven by a person or persons in a way to contravene state and territory laws. 2. Liability 2.1 The hirer shall ensure that the hire vehicle is: a) Kept in a state of roadworthiness that complies with state and territory transport regulations. 2.2 The hirer shall be liable for: a) Fines or charges payable as a result of any traffic or parking offences or violation which occur during the period of the vehicle/s hire. b) All cost incurred other than those covered by State Fleet under this agreement. c) Any damaged caused to person/s or properties not covered by comprehensive or third party insurance. 3. Fuel purchase a) Every vehicle hired under the State Fleet Short-Term Hire agreement is issued with one fuel card. This card will cover all fuel purchases for the period of hire. b) The fuel card will be delivered to the address stated on the application form within two days of receipt of application. 4. Repairs a) Every vehicle hired under the State Fleet Short-Term Hire agreement is covered for scheduled servicing and repairs ie, tyre and windscreen replacement. b) When servicing or repairs is required, contact State Fleet repair centre on 1800 801523 for the nearest contracted repairer. 5. Insurance a) Short Term Hire vehicles are covered by State Fleet for Comprehensive Insurance, however, the hirer will be liable for a $1000 excess payment for Cars and $2000 excess payment for 4WD & Commercial vehicles for each claim. Please Note: The ExtraCar rental agreement does not insure you for any overhead or undercarriage damage, nor does it cover costs incurred through negligence or abuse.