Rentals Department of Countryside Auto Inc

First Name:

Last Name:

Email:

Mobile Phone:

Home Phone:

Time To Call:

Date of Contact:

Date of Pickup:

Date of Return:

Vehicle Type:

Vehicle Year:

Vehicle Make:

Vehicle Model:

Comments:

ACKNOWLEDGMENT AND CONSENT:

I hereby consent to receive text messages or phone calls from or on behalf of the dealer or their employees to the mobile phone number I provided above. By opting in, I understand that message and data rates may apply. This acknowledgement constitutes my written consent to receive text messages to my cell phone and phone calls, including communications sent using an auto-dialer or pre-recorded message. You may withdraw your consent at any time by texting "STOP".