Hideout Camper Registration Form

Customer Information

First Name(s) *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number #1 *

Email Address #1 *

Birth Date * +

Driver's License # *

Additional Information

Start Date * +

End Date * +

How Many People *

Where will you be Traveling? *

Will you need delivery?

Which camper is available for the dates you are requesting? *

Any additional Information you need to add?

What type of vehicle will you tow the camper with? *

Credit Card Authorization Information to Hold for Deposit (30 Day Cancellation Fee)

***PLEASE READ BEFORE FILLING THIS OUT*** ALL FORMS SUBMITTED ARE SUBJECT TO A $40.00 CANCELLATION FEE*** Please see the website for all rules and/or policies on renting a camper.

In order to secure your rental dates with AJ's Camper Rentals, we require a credit card (not debit card) to be held on file. This is in place of having to send in deposit checks. We do not use this card for anything other than holding purposes and we will not use this card to pay your rental fee. You will always be sent a secure link to pay online if you wish or you can pay with cash or check upon arrival. AJ's Camper rentals has a 30 day cancellation period. The only time this card would be used if you did not cancel prior to the 30 days or if needed for a insurance deductible.

Credit Card Type *

Name as it Appears on your card: *

Credit Card Number *

Expiration Date (mm/yy) *

3 Digit Code: *

Signature *

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