EmailMe Form - Car Hire Booking Form

Name *

First Last

Email *

Phone *

Please enter your phone number including your country code

Pickup Date *

DD / MM / YYYY

Return Date *

DD / MM / YYYY

Car Type *

Other Information

Credit Card and Personal Information

Please make sure we have confirmed availability before submitting credit card details

Credit Card *

Name On Credit Card *

First Last

Please enter the full name as listed on the credit card

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Please enter the address associated with the credit card

Signature *

Clear

Signature on the back of the credit card

Terms

All car hire rates are inclusive of GST and a 4.0% credit card surcharge.
Rates are listed in Samoan Tala (WST).
Payment in full required to confirm car hire booking.
Your car hire booking is not confirmed until you have received a booking confirmation email from The Samoan Outrigger Hotel.
I authorize The Samoan Outrigger Hotel to charge my credit card above for my car hire booking. I understand that my information will be saved in a Secure Vault for future transactions related to my car hire booking as long as is necessary.

Terms *

I agree to the Terms