Customer Profile
* Last Name
* First Name
* E-mail
* Phone
P.O. #
Claim #
Insurance Company Name
Payment Type (Payment will be accepted at time of rental.)
Rental Details
* Location Van is Needed:
Pick Up Date (MM/DD/Year)
/ /
Pick Up Time
Full Size Van with Lift
Daily Rental $99.00     Mini Van with Ramp
Drop Off Date (MM/DD/Year)
/ /
Drop Off Time
As a condition of renting a vehicle from WAV, you will be required to accept and sign our terms and conditions document upon pick up.   * Required Field
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