Please Sign & Fax the Following Form to Cool Breeze Car Rental, Inc at
Fax 340/693-8078

If you have any questions, please call us at 340/776-6588

All drivers must be 25 years or older.
If you would like to charge on your Credit Card, please fill out the following form:

I personally authorize Cool Breeze Car Rental, Inc. to charge a deposit in the amount of
$___________, to the following Credit Card in my name (For refunds, reservations must be
cancelled 3 weeks in advance of reservation):

(    ) VISA     (    ) MasterCard     (    ) American Express

Name (same as on card): _________________________________________

Account Number: ______________________________________________

Exp Date: ______ if Amex, we need the 4 numbers on the right side ________

Signature: ____________________________________________________

This deposit is to be used towards the rental of a _______________________
Vehicle type

Beginning Date: ______________ through Ending Date: _________________

My Contact Information is:

Name: ______________________________________________________

Address: ____________________________________________________

City/State/Zip: ________________________________________________

Phone: ______________________________________________________

Fax: ________________________________________________________

Email: _______________________________________________________