Acorn Rentals

Replacement Vehicle Application Form

All fields marked with * are required.

If you do not know any of the required information please mark box as unknown or N/A. Please complete the form as thoroughly as you can.
Acorn will contact you as soon as we have taken the necessary steps to approve your application, so please leave all of your contact phone numbers.
If you have any problems or questions please don’t hesitate to contact us by phone on 1300 226 767 for assistance.

Click here to print and fax an Application Form

Click here to view our Terms & Conditions of Hire

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PARTY NOT AT FAULT

Driver

* Name

* Address

* Suburb

* State

* Post Code

* Mobile Telephone

Work Telephone

* Home Telephone

Fax Phone

* Email Address

* Age of Driver

Owner of Vehicle ( Same as Driver: )

* Name

* Address

* Suburb

* State

* Post Code

* Phone Number

Vehicle Details

* Vehicle Rego Number

Make

Model

Year

Insurance Details

Type of Cover

Comprehensive Third Party Only Nil

Insurance Company

Claim Number

* Are you claiming repairs under your own policy?

Yes No Unsure

* Is your vehicle registered for GST?

Yes No Unsure

If yes, ABN#

PARTY AT FAULT

Driver

* Name

* Address

* Suburb

* State

* Post Code

* Mobile Telephone

Work Telephone

* Home Telephone

Fax Phone

Owner of Vehicle ( Same as Driver: )

* Name

* Address

* Suburb

* State

* Post Code

* Phone Number

Vehicle Details

* Vehicle Rego Number

Make

Model

Year

Insurance Details

* Insurance Company

* Claim Number

ACCIDENT DETAILS

* Date

* Time

* Street Name

* Suburb

* Number of Cars involved

Details of Other Drivers Involved (If More Than 2)

Name

Phone Number

Name

Phone Number

Name

Phone Number

Name

Phone Number

* Accident Description (in detail)

* Who admitted liability?

Party At Fault Nobody

* Admitted verbally or in writing?

Verbally In Writing Both Not Admitted

* Did police charge anyone?

Yes No Unsure

* Is the other party disputing liability?

Yes No Unsure

* Is your vehicle drivable / legal?

Yes No Unsure

Repairer Details

* Repair Shop Name

* Date Vehicle Required

* Date Vehicle Admitted to Repair Shop

How Did You Hear About Us

* How Did You Hear About Us

Please type the verify code as you see it in to the box below.

* Verify Verify