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Customer Name
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Full Name
If minor (under the age of 18 years) Name of adult
Full Name
Home Address
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Full Home Address and Postcode
Phone
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Email
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Rental Item Details
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Name of Item
Size
*
Size 6
Size 8
Size 10
Size 12
Size 14
Size 16
Handbag
Size of Item or Handbag
Rental Price
*
Rental Price of Item
Date of Collection
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Date of Return
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Credit Card Name
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Credit Card Number
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Credit Card Expiry Date
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CVV
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I,
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acknowledge that I have reviewed and agree to all the terms and conditions as stated on www.savethedate-dh.com.au as at the below date.
Date
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