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Pre-Rental Order Form

Please complete This form and one of our rental consultants will contact you within 24 hours. For immediate quotes please call us directly at 1-800-822-6677 Monday through Friday 9am-6pm EST.

(* Required Field)

Contact Information
Company Name *
Contact Person *
Phone *
Fax
E-mail *
Address *
City*
State *
Zip Code *
What is the best way for us to contact you?
Phone
E-mail
Mail
Billing Information (if different from above )
Name
Address
City
State
Zip Code
Shipping Information (if different from the billing address )
Name
Address
City
State
Zip Code
Equipment
Event Name
Date Equipment is to Arrive*
Date Equipment to be Shipped Back *
Rental Start Date *
Rental End Date *
Delivery Method *
Radio Information:
Portable Radios
Qty
 
   
Mobiles
Qty
 
   
Intrinsically safe rentals

Yes

   
Base Stations
Qty
   
Repeaters
Qty
   
Disposable Earpiece
Qty
   
Surveillance Kit
Qty
   
Remote Spkr Mic
Qty
   
Light Duty Headsets
Qty
   
Med Duty Headsets
Qty
   
Heavy Duty Headsets
Qty
   
Spare Batteries
Qty
Notes if any special programming needed
Do you need us to provide you an On-Site Support Staff?
Yes
No
   
Promotional Code If any
   
   
How did you hear about us?
Association Name (if any)
 
Please let us know other if there is any Equipment or Accessories not listed that you also want a quote for:
 
 

 

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