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Head Office : Jalan Mampang Prapatan Raya No.

60, Jakarta 12790

Phone : 7989000, 7989111 (Hunting), 7944444 - Marketing Departement : 7971222

SALES ORDER NO : INVOICE NO :


Cust. No : Name :
Company : Pick Up Anddress :
Address :

Phone :
Contact Person :
Phone :
G.B. REPRESENTATIVE USE ONLY CHARGES
Order/Contract No : Destination
Car Type : Hourly
Plate No : Daily
Each additional
Driver's Name : hour
GB Rep : Each additional day
Each additional 1/2
Date : day
Depature Time : Exchange rate
Usage : Price does not include toll & parking fees, except airport transfer
Payment Type : FILLED IN BY CUSTOMER
Down Payment : Finish
MC/COF/inv.CC No. : Date
Replacement Car No. : Time
KM start : Amount paid
KM finish : Rp/USD
Payment Charge to :
Additional charge to :
Tol DK APSH Signature
Cash Bon : Please make sure you do not leave any of your belongings in the car
COMPUTER USE ONLY
Invoice No.
No.LGN UM DP T+P

SETOR UP DC TG ML TG SL
Page 1 : For customer cash only - Page 2 : Administration - Page 3 : Outlets

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