Blue Chip Application

Title *
First Name *
Last Name *
License Number *
Country of Issue *
State of Issue Australia Only
Expiry Date * DD/MM/YYYY

Note: Renters must be aged 21 to 75 years inclusive and hold a full and valid drivers licence

Birth Date * DD/MM/YYYY
Gender * MaleFemale

Phone / Mobile
Fax
E-mail

As shown on Drivers License - No PO (Post Office) Boxes

Address *
Suburb *
State *
Post Code *

If different to Home Details above

Address
Suburb
State
Post Code

Name
Address
Suburb
State
Post Code

The form of payment is compulsory and must be provided to process your application

Thrifty Account Number (If applicable)
Thrifty Corporate Discount (CD) Number (If applicable)

Please provide credit card details except where Thrifty Account Number or CD Number starting with 4909 has been provided

Card Type
Card Number
Expiry Date MM/YYYY
Name on Card

Standard Cover

Is included in your rental fee, and indemnifies the Hirer and Authorised Drivers for damage to the Thrifty Vehicle and Third Party Property, subject to the Terms and Conditions. The Loss or Damage Cover Fee and Single Vehicle Accident Liability Fee will apply.

Premium Protection

Is an additional charge which reduces the Loss or Damage Cover Fee. In addition the Single Vehicle Accident (SVA) Liability Fee is not payable in metro locations and may apply in country and remote locations, and Tyres and Windscreen damage is covered, where accidental.
Please note once selected this will be a mandatory charge against your profile unless otherwise notified in writing to the Blue Chip Department.

Please select your preferred vehicle type

Small
Compact
Intermediate - Sedan
Intermediate - Wagon
Standard
Full Size - Sedan
Full Size - Wagon
Prestige
Luxury
Other
Please specify

Satellite Navigation System
Child Seat
Booster Seat

** are at an additional cost and subject to availability, must be requested at time of booking

How many times do you rent per year?

1 to 2
3 to 5
6 to 9
10+

Reason for hire?

Leisure
Business
Other
Please specify

Qantas Frequent Flyer Number

Please indicate whether you wish to be included in any Thrifty Blue Chip special offers and updates.

YesNo

Please enter any further comments that will assist us with your application

I agree to the Terms and Conditions of the Blue Chip Program

Blue Chip Application

Personal Details

Contact Details

Home Details

Postal Details

Company Details

Billing Preferences

Preferred Protection Level

Preferred Vehicle

Optional Extras **

Rental Information

Reward Programs

Specials and Promotions

Comments

Declaration