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Online Application Form

Thank you for choosing Perth Rentals Hire for delivery in Perth, Western Australia. Please complete the following form with as much details as you have available.

Enter The product & Period (months) you wish to rent for:

(if possible please include product description...eg 5kg washer and 220ltr fridge)

Surname :
First Name:
Middle Name :
Drivers License :
Date of Birth :
Phone :
Mobile :
Email :
Address :
How Long : Years Months
Previous Address:
How Long Years Months
Permission to do a credit check?
 

Address: 6 Goongarrie Street, Bayswater, Western Australia 6053 | Phone: 9379 7344