Blue Wing Membership Application Form

Please submit the below form to join our Blue Wing Club.  Alternatively you can download the pdf file which contains the application, terms and conditions and rental agreement.  Complete the form and fax back to 03 546 7381 or post to our National Support Office, PO Box 7166, Nelson.

* please note red fields are required

Personal Details

First Name

Middle Initial

Last Name

Date of Birth

(Day)01020304050607080910111213141516171819202122232425262728293031(Month)JanFebMarAprMayJunJulAugSepOctNovDec(Year)1994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928

Email

Home Address

Phone

Fax

Mobile

Business Details (if applicable)

Business Name

Business Address

Business Phone

Business Fax

Preferred Mailing Address

BusinessHome

Licence Details

Licence No

Country of Issue

AfghanistanAlgeriaAngolaAntarcticaArgentinaAustraliaAustriaAzerbaijanBangladeshBelarusBelgiumBelizeBermudaBhutanBotswanaBrazilBruneiBulgariaBurmaBurundiCambodiaCameroonCanadaCayman IslandsChadChileChinaChristmas IslandColombiaComorosCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEritreaEstoniaEthiopiaFijiFinlandFranceGabonGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuyanaHaitiHawaiiHondurasHong KongHowland IslandHungaryIcelandIndiaIndian OceanIndonesiaIranIraqIrelandIsraelItalyJamaicaJan MayenJapanJarvis IslandJerseyJohnston AtollJordanKazakhstanKenyaKingman ReefKiribatiKorea NorthKorea SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMoldovaMonacoMongoliaMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoReunionRomaniaRussiaRwandaSamoaSan MarinoSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTahitiTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin IslandsYemenZambiaZimbabwe

Expiry Date

(Day)01020304050607080910111213141516171819202122232425262728293031(Month)JanFebMarAprMayJunJulAugSepOctNovDec(Year)2027202620252024202320222021202020192018201720162015201420132012

Vehicle Preferences

Preferred Vehicle Type

Please SelectSub CompactSub Compact Late ModelCompactCompact Late ModelCompact StationwagonIntermediateIntermediate StationwagonExecutiveSports4WD Intermediate StationwagonPeople Mover 6-8 seatsMinibus 9-12 seatsOther (Please specify in comments area)

Preferred Vehicle Transmission

No PreferenceAutomaticManual

Payment Details

Preferred Payment Type

Credit CardCharge Account

(If you choose 'Charge Account' an application form will be sent to you).

You will be contacted by our National Support Office for your credit card details to process your application.

Insurance Details

You are liable for an amount up to the sum specified in the attached conditions of hire in respect of the damage to or loss of the vehicle. To reject the insurance cover, you must provide a letter from your insurance company confirming policy details.

I wish to receive an application form for insurance rejection.

I wish to take out Collision Damage Waiver on all hires (see conditions).

Additional Details

Comments/Notes

I acknowledge that I have read and agree to the Terms & Conditions of the Blue Wing club and the agreement to hire a rental vehicle. I confirm that the above information is correct.

By completing this form you authorise Pegasus Rental Cars to hold information collected about you for the purposes of your rental activity. We will regularly keep you informed by newsletter of any special offers. Your information is confidential and will never be given out to another person or company.