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FCA Portal
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Form – FCA
Please fill out the form below:
Dealership details
AJ Code
*
Dealership
Contact Name
Contact Email
Contact Number
Customer VIN
*
Vehicle Off Road Number
*
Dealership PO Number
Representative Email Address
*
Booking Details
Driver First Name
*
Driver Last Name
*
Driver Email
*
Driver Mobile Number
*
Vehicle Make
*
Please Select
Jeep
Alfa Romeo
Fiat
Vehicle Model
*
Please Select
Driver Licence
Driver Rego
*
Comments
*
Delivery Details
*
Please Select
Customer
Dealership
Delivery Address
*
Delivery Suburb
*
Delivery State
*
Please Select
NSW
VIC
QLD
TAS
WA
SA
Delivery Date
*
Delivery Time
*
Special Requirement
Collection Details
Same as Delivery
*
Please Select
Yes
No
Collection Address
*
Collection Suburb
*
Collection State
*
Please Select
NSW
VIC
QLD
TAS
WA
SA
Collection Date
*
Collection Time
*
Please advise your client:
*
R2D will request a debit/credit card (tolls/fines/damage)
R2D will check that you have an Australian licence with no restrictions (ie Interlock)
Client/Partner/Spouse to meet R2D staff to sign/receive rental agreement
NO pets in R2D cars
NO smoking in R2D cars
Return car with a full tank of fuel
Return car in a clean condition
R2D vehicles cannot be taken off road/snow/sand etc
Submit