Scooter reservation form

Renter personal data
Full name:
Date of birth:
Citizenship:

Document
Document:
Series, number:
Issued by:
Date of issue:
Date of expiration(for foreign passport):

Address according to registration
City:
Street:
House:
Building:
Flat:
Phone:

De facto address of residence
City:
Street:
House:
Building:
Flat:
Phone:

Place of employment
Place of employment:
Position:
Address of the place of work:
Phone:
Cell phone:
E-mail:

Driver's license
Series, number:
Date of issue:
Issued by:
Date of expiration:

Information about parents
Father (full name):
Place of employment:
Position:
Work phone:
Mother (Fill name):
Place of employment:
Position:
Work phone:

Ask for a scooter
Scooter group, make:
Period
from:
to:

Check in/out offices
Check in:
Check out:
Approximate area of scooter use and parking Scooter:
Method of payment