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Capital Group Insurance Ltd

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Private Ride Hire

Private Transport Hire Services Order Form

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Mobile No.(Required)

Provide full details of your hire request.

Hire Date(Required)

MM slash DD slash YYYY

Pick-Up Time(Required)

Hours

:

Minutes

AM/PM

Pick-Up Location(Required)

Destination(Required)

Number of Passengers(Required)

Please enter a number greater than or equal to 1.

Return

Tick if you wish to make a return trip

Return Pickup Time(Required)

Hours

:

Minutes

AM/PM

Number of Passengers(Required)

More Bookings

Tick if you'd like to make more bookings

If you intend to make more bookings, please complete the form below.

Additional Bookings(Required)

Please list every trip both pickup and return to help us schedule your trip.

Date/Time

Pick Up

Drop Off

PAX

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