Registration - Wongai 4wd Hire

Basic Information

Wongai Quote Number *

This Is written at the top of your quote

How Many Drivers Are In Your Group? *

Driver Details

Driver 1

Name *

First

Last

Date of Birth *

Gender *

Male
Female

Driving Licence Number *

Full Street Address *

Email Address *

Confirm Email

Phone Number *

Driver 2

Name *

First

Last

Date of Birth *

Gender *

Male
Female

Email Address *

Phone Number *

Driver 3

Name *

First

Last

Date of Birth *

Gender *

Male
Female

Driver 4

Name *

First

Last

Date of Birth *

Gender *

Male
Female

Terms and Conditions

In the last 3 years, have you or anyone to be covered under this policy had an insurance policy declined or cancelled, a renewal declined, special terms imposed, or had a claim refused? *

In the last 3 years, have you or anyone to be covered under this policy committed any criminal act in relation to fraud, theft, burglary, drugs, arson, criminal damage, malicious damage or wilful damage? *

*Details of previous claims, driver licence suspensions, cancellations, disqualifications or restrictions in the last 3 years (if any):

I have read and agree to the Road Trip Contract (www.wongai.com.au/RoadTripContract) *

I Agree

Wongai Support (Age of the Youngest Driver) *

21 - 22
23 - 26
27 - 30
31 - 75

Drivers Under the Age of 21 are not permitted to drive the vehicle.

Where Are You Travelling To?

Mainland Queensland Only
K'Gari (Fraser Island)
Moreton Island
Stradbroke Island
Different Off-Shore Island
Interstate

You can select more than one

What Optional Extras Would You Like For Your Trip? *

UHF Radio (Handheld)
Side Awning (Not Allowed on Fraser Island)
Annex For Roof Top Tent
230V Charging Facility
Large 50l Premium Esky
23l Emergency Water Tank
Extra Camping Chair
Camping Stove
Extra Camping Chair
Cutlery, Pots, Pans, & Plates
Fuel Jerry Can
None

Booking Type *

Deposit Only ($500 non-refundable)

Special Requests or Extra Information

Card Details *

Card

Name on Card