RENTAL FORM

SELECT YOUR MOTORBIKE

 
Moto
quantity
BMW R 1200 GS
BMW F 800
 
 
Motorcycle leased (TO BE COMPLETED BY THE COMPANY)
Registration Number
Brand
Model
Engine Number
Color
Chassis Number
Year

Details of official driver
Driver (First second and last names)
Nationality
Country of Birth
Passport / ID Number
Place of emission and Expiration Date of the passport
E-mail
Residential Address
City
Country
Profession
Telephone Number
Drivers License Nº - place of emission and expiration date
Health insurance Yes  No
Company
 
Drivers Medical information
Blood Type
Allergies
Heart diseases
Yes No Which
Do you take medication on a regular basis
Yes No Which
Other type of disease
Yes No Specify
Note: Lessee / Driver declare under his/her responsibility to be in good medical and physical condition suitable for this type of trip. In the event that during the trip, the participant suffered decompensation, accident and / or death due to a disease or illness, the company will not be responsible for that event.
 
Accessories
top case
Yes No
side Cases
Yes No
Removable inner bag
Yes No
Helmet
Yes No
Riding Pants
Yes No
Riding Jacket
Yes No
Boots
Yes No
Gloves
Yes No
GPS
Yes No
Puncture Repair Kit
Yes No
Mobile phone
Yes No
Fuel level
Full Empty
 
Observations
 
INSURANCE TAKEN OUT FOR THE MOTORCYCLE
Coverage
Deductable
 
Period of duration of the contract of Lease of the Motorcycle
Term of Lease Days
Commencement Date
Finish Date  Extention 
Place of return of the leased vehicle

   
Emergency Contact (official driver)
Full Name
Telephone and Mobile number
Relationship with the Participant:
 
Companion
Name and Surname
Passport / ID Number
Place of emission and Expiration Date of the passport
E-mail
Residential Address
City
State
Country
Telephone Number
Health insurance Yes  No
Company
 
Medical Information of the Companion
Blood Type
Allergies
Heart diseases
Yes No Which
Do you take medication on a regular basis
Yes No Which
Other type of disease
Yes No Specify
Note: Lessee / Driver declare under his/her responsibility to be in good medical and physical condition suitable for this type of trip. In the event that during the trip, the participant suffered decompensation, accident and / or death due to a disease or illness, the company will not be responsible for that event.
 
Emergency Contact (Companion)
Full Name
Telephone and Mobile number
Relationship with the Participant:
PAYMENT
Rate Chilean Pesos
Rate USD
Total Payment
Form of payment
Observations
 
Statements and expression of will.

The grantors of this document declare that it is their will to sign the present contract according to the conditions contained in the previous chapters;
to follow it in good faith and declare the document called 'General Conditions for Motorcycles and Tourist Services Lease Contract', essential to this contract,
which they declare to know and agree completely, submitting to its requirements. In equal terms the Lessee, as Driver and as Companion in his/her case,
accepts SERVICIOS TURISTICOS SOUTH AMERICA MOTORBIKE TOURS LIMITADA is in charge of the organization and instructions for the leasing of the bikes.
Equally the Lessee, as Driver and as Companion accept and commit to subscribe in this act a document entitled , Fee Authorization for my credit
card operated by Transbank and a Declaration of Resignation of Responsibility, which terms the Lessee, as Drivers and as companion declare to know and accept.

Default or damage of the Motorcycle - South America Motorbike Tours Limitada - reserves the right to repossess a motorcycle and terminate the
Tour/motorcycle lease, for the lessee, as driver and as companion failing to comply with the terms and conditions of the rental agreement , or should
the motorcycle be damaged.

As proof, they sign in Santiago , Day Month Year