At Fault Application Form

If you are at fault in the accident, we may be able to provide you with a replacement vehicle and be paid directly from your insurance company. To be eligible you will need to have the replacement vehicle option under your insurance policy and we will need a copy of your insurance policy. You can upload it via this application form, email it to admin@acornrentals.com.au or send a photo of it to 0418 757 533.

If you have any questions or would prefer to make this application via phone please call our trained staff on 1300 22 67 67.
Driver’s Name **
Start typing your address then select it from the drop down list*
Start typing your address then select it from the drop down list

Street Address City State / Province / Region ZIP / Postal Code
Driver’s Mobile Phone Number **
Driver’s Work/Home Phone Number
Driver’s Email Address **
Was the driver the registered owner of the vehicle?
- Yes
- No
Registered Owner’s Details
*
First Last
Start typing your address then select it from the drop down list*
Start typing your address then select it from the drop down list

Street Address City State / Province / Region ZIP / Postal Code
Registered Owner’s Phone Number **
Vehicle Details
Vehicle Registration Number **
Make
Model
Year
Insurance Details
Insurance Company **
Claim Number
Do you have a replacement vehicle option in your car insurance policy? **
- Yes
- No

Acorn RMS

If you are not already an Acorn RMS user, please enter the information below and we will contact you to set you up shortly.

Registered Owner’s Details