Reservation Pay Cash
4% discount Mirage Car Rental

* Required Fields

Personal Information
* Name
* E-mail
Country	- United States Canada Argentina Australia Austria Belgium Brazil Chile Colombia Costa Rica Denmark Ecuador El Salvador Finlandia France Germany Greece Guatemala Honduras Ireland Israel Italy Japan Luxemburg Mexico Middle East New Zealand Nicaragua Nigeria Norway Panamá Paraguay Perú Poland Portugal Russia South Africa Espain Sweden Switzerland United Kingdom Uruguay Venezuela Other
# adults	# Childrens Ages?
Arrival Flight N
Airline Company
Telephone
How did you find us?	Not sure Ticotimes AOL Yahoo Google Overture Lycos HotBot Alta Vista Excite Metacrawler Other engine Recommended Already knew Previous client
Service Information
Type of Car	----- Sedan Subcompact Spark Manual Sedan Compact Yaris Manual Suv Compact Terios Manual Suv Compact Terios Automatic Suv MidSize Rav4 Manual Suv MidSize Rav4 Automatic Suv MidSize Outlander Manual Suv MidSize Outlander Auto Suv Full Size X-Trail Manual Suv Premiun Man Vitara XL7 Suv Premiun Terracan Suv Premiun Auto Vitara XL7 Other List of cars
Additional Driver	Yes
Child restraint System	Yes
Roof racks	Yes
Under Age Insurance	Yes
Cell phone	- No Yes
GPS ?	- No Yes
PICK UP:	Day - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month - Jan Feb Mar April May June July Agoust Sept Oct Nov Dec Year - 2011 2012 2013 2014 Hour -- 00:00 00:30 01:00 01:30 02:00 02:30 03:00 03:30 04:00 04:30 05:00 05:30 06:00 06:30 07:00 07:30 08:00 08:30 09:00 09:30 10:00 10:30 11:00 11:30 12:00 12:30 -- AM PM
DROP OFF:	Day - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month - Jan Feb Mar April May June July Agoust Sept Oct Nov Dec Year - 2011 2012 2013 2014 Hour -- 00:00 00:30 01:00 01:30 02:00 02:30 03:00 03:30 04:00 04:30 05:00 05:30 06:00 06:30 07:00 07:30 08:00 08:30 09:00 09:30 10:00 10:30 11:00 11:30 12:00 12:30 -- AM PM
Pickup Location	- San Jose Airport Pavas Airport Liberia Airport San Jose Location Guapiles City Arenal City My Hotel Other Place Not Secure to be advise
Dropoff Location	- San Jose Airport Pavas Airport Liberia Airport San Jose Location Guapiles City Arenal City My Hotel Other Place Not Secure to be advise See Drop off Fee
Credit card Information
* Type Credit Card	- VISA MASTERCARD
* Credit Card Number
* Expiration Date	Month - 01 02 03 04 05 06 07 08 09 10 11 12 Year - 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
* Secure Code
Additional Comments	-

Phones in Costa Rica: (506) 83 55 11 09 / (506) 88 61 10 43 (506) 2430 98 01 Fax: (506) 2441 6801 E-mail: info@miragecarrental.com