You could try renting a car from Holiday Autos (based in the UK but using good local hire companies) or go to the Pisa Airport website and see which of the major players have a branch at the airport.

We flew to Pisa in sept 06 and had pre booked a hire car from Holiday Autos, I don't recall which rental company they used but everything worked out fine. We were returning the car out of office hours and just dropped the keys through the letter box.

I've never had a problem using my paper license anywhere in Europe.

Hello, I live in Italy, having rented the car at Pisa careful to find that speed on the highway in the direction of Florence on max speed limit is 90Km / h. In the streets outside the car headlights must be turned on. If the police makes you a fine you must pay in cash immediately otherwise there is his vehicle at your expense. bye bye