Pre-ordering form - Bluecar by Pininfarina

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Last name
First name
Company
Address
Post code
City
Country
Work phone
Mobile phone
E-mail
Gender	FM
Age range	<2525/3535/45>45
Nationality
Profession
How many cars do you own?
How many kilometers do you spend per day?
Your car trips are mostly	UrbanRoadBoth
Your professional activity is	SedentaryMobile
Number of Bluecar
Comments

I am interested in renting the BLUECAR electric car which is to be produced by Véhicules Électriques Pininfarina Bolloré and would like to pre-order one.

I am aware that owing to the limited production run of this vehicle, my pre-ordering request will undergo a selection process according to rules to be determined by Véhicules Électriques Pininfarina Bolloré and that should it be chosen, I will be sent a pre-ordering contract.

Should I decide to commit to this pre-ordering contract, I pledge to sign it and send it back together with a down-payment of €330 which will be deducted from the rental cost or will be reimbursed to me in full should I not be allocated a car.

am aware of the fact that I have a 7 day cooling off period as of the date on which I send back my pre-ordering form during which I can change my mind and withdraw, and that in accordance with France’s data protection law of 6 January 1978, I am entitled to access, modify, rectify or delete personal information relating to myself that is stored at the headquarters of Véhicules Électriques Pininfarina Bolloré, by writing to the following address: VÉHICULES ÉLECTRIQUES PININFARINA-BOLLORÉ 31/32, quai de Dion Bouton - 92800 Puteaux - France Registered in Nanterre, France under no. 502 466 931