Comments or Questions:
(name and address must match credit card)
Check if same as billing information
Send Billing Statement Via: (check one)
($2.00 Charge Applies)
Credit Card Information:
3 or 4 digit CVV: (what's this?
(We do not accept debit or check cards)
(your information is transmitted to us securely)
Date of Your Departure:
Date Of Return:
# Of Phones Needed:
Countries to be visited:
Rental Choice: (please choose all that apply)
(Yes, $1.50 per day / $75 deductible
No, $350 fee for non-insured loss of equipment)
Travel With U.S. Number?
On what search engine did you find us?
Comments and Questions:
(your phone will be delivered at least 2 days before departure date)
Terms and Conditions:
A credit card authorization of $300 will be processed.
This is NOT a deposit or a charge taken from your card.
By placing this order, I hereby authorize my signature for the above rental agreement and agree to the
terms and conditions
of rental and authorize ICS to bill all applicable rental charges associated with this agreement to my credit card provided above.
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2009-2011 International Cellular Services
Call us at 1-800-878-1255 to order
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