FORM

Please fill out the form below.

     
 
surname
 
 
first name
 
 
adress
 
 
postal code
 
 
town
 
 
country
 
 
phone
 
 
fax
 
 
e-mail
 
 
special request
 
 

TARIFFS in RD$
Model
Per day
CAT 1
FORD Festiva (2000)
650 RD$
CAT 2
TOYOTA Corolla (1992)
600 RD$
CAT 3
TOYOTA Corolla (1994)
650 RD$
CAT 4
TOYOTA Corolla (1995)
700 RD$
CAT 5
TOYOTA Corolla (1996)
750 RD$
CAT 6
NISSAN Sentra (2000)
800 RD$
CAT 7
TOYOTA Yaris (2000)
850 RD$
CAT 8
PONTIAC Van (1999)
1250 RD$
CAT 9
Jeepeta Nativa (2000)
2250 RD$
CAT 10
Jeepeta Blazer (2000)
1600 RD$
 
 
ARRIVAL DATE
   
 
N° days
 
 
Type of car
 
 

METHOD OF PAYMENT

 
 
1)At the reservation20% of the total cost by:
Cheque Credit card  
 
2) Balance: 80% to the car rental
at your arrival

Credit card

 
 

If payment by cheque (20%), please send it at the order of :

DOMIEXEL Sarl

57 Av du Général DE GAULLE
97190 GOSIER
GUADELOUPE

 

As soon as we'll receive your cheque your reservation will be confirmed

 
 
 
 
SECURED PAYMENT BY CREDIT CARD
Choose your credit card
Card number
Date validity
Total reservation
I AUTHORIZE YOU TO DEBIT MY CREDIT CARD
FOR THE AMOUNT OF :

CORRESPONDING TO  20% of the total of the reservation

THIS DEBIT WILL BE DONE AFTER OUR CONFIRMATION