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Sixt Cards - Card Application Form

Name and private address
Salutation *
Title
Name *
Firstname *
Street *
Country
Post Code *
City *
Private phone *
e-mail *
Date of birth *

Company Address
Company name
Contact Number **
Legal form
Managing Director
Street
Post Code
City
Office Phone
e-mail

Driving licence information
No. of driving licence *
Issuing office *
Dated from *

Payment information
Your personal credit card which you expect to use for payment
Credit Card *
Card-No. *
Expiry Date *
The personal data saved by Sixt is used in accordance with the regulations and provisions of the applicable data protection law. Please note: before receiving your Sixt Card we’ll charge off 1 Euro from your Credit Card to check correctness of input data. This amount will be returned to your card during 30 days after charging off!

Information of your partner's card
Sixt Card No.
Last name
Firstname

Comments (e.g. existing SixtExpress No.)

(*) Mandatory fields.

(**) If available.