Name

Address

City		State/Province		Postal Code

Country

[Please select your country...] United States Canada Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina FASO Burma Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Espana Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (South) Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa (Independent) San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka St. Helena St. Pierre And Miquelon Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S.A. Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wales Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe

Email Address

Telephone number

Can you drive with a manual stick shift transmission?

yes     no

Your journey

Pick up date & time		Drop off date & time
[Select...] 4:00am 4:30am 5:00am 5:30am 6:00am 6:30am 7:00am 7:30am 8:00am 8:30am 9:00am 9:30am 10:00am 10:30am 11:00am 11:30am Noon 12:30pm 1:00pm 1:30pm 2:00pm 2:30pm 3:00pm 3:30pm 4:00pm 4:30pm 5:00pm 5:30pm 6:00pm 6:30pm 7:00pm 7:30pm 8:00pm 8:30pm 9:00pm 9:30pm 10:00pm 10:30pm 11:00pm 11:30pm Midnight		[Select...] 4:00am 4:30am 5:00am 5:30am 6:00am 6:30am 7:00am 7:30am 8:00am 8:30am 9:00am 9:30am 10:00am 10:30am 11:00am 11:30am Noon 12:30pm 1:00pm 1:30pm 2:00pm 2:30pm 3:00pm 3:30pm 4:00pm 4:30pm 5:00pm 5:30pm 6:00pm 6:30pm 7:00pm 7:30pm 8:00pm 8:30pm 9:00pm 9:30pm 10:00pm 10:30pm 11:00pm 11:30pm Midnight
There is a three day minimum rental.

Number of people in your party

Adults:   Children:   Children's ages:

Insurance

How do you intend to provide insurance for your rental?

Purchase from Aloha Campers (at $12 / day)
I will provide evidence of full coverage

Insurance company:
Policy #
Insurance company phone:

Optional equipment

	Child seats ($15 each)			Folding table ($10)
	Lawn chair ($5 each)			Portable toilet ($25)
	Camping kit at $25 (The camping kit includes 2 sheets, 2 towels, 2 pillows, and 2 blankets.)
(Note that all rates are per trip.)

Comments or Questions