Tanda Terima

Nama Penyewa : ....................................... No. KTP/SIM : .................................................

Alamat : .................................................................................................................
Telp. : .................................................................................................................
Jumlah Mobil : ......................................... Unit No. Pol. : ................................................
Jenis Kedaraan Lama : .........................................
Sewa : ......................................... Bensin
Tanggal di Ambil : ......................................... Jam : .......................................................
Tanggal dikembalikan : ......................................... Jam : .......................................................
Biaya Sewa : Rp. .................................. Biaya Denda : Rp. ......................................
Keterangan Lain : .................................................................................................................

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