Customer Profile

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Date *

Pickup Location

Name of Customer *

Passport No. *

Sponsor Name

Visa Type

Nationality

Email *

Emirate

Mobile No *

Credit card authorization

I hereby authorize Lumiere Car Rental a Car to charge the below credit card for this rental/lease agreement, extensions, salik, traffic fines, damages or any other incidental charges such as fuel, additional drivers, delivery etc. This authorization will continue until the end of the rental/lease contract.

Name on Credit Card *

Expiry Date *

Credit Card Type

Issuing Bank *

Credit Card Number *