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RENTAL ORDER FORM
Contact Name
First
Last
Phone
Email
Company Name
Company Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Job Name
PO#
Rental Period Start
MM slash DD slash YYYY
Rental Period End
MM slash DD slash YYYY
Delivery/Pick Up
Delivery
Pick Up
* Delivery Fee may apply!
Pick Up Time
Hours
:
Minutes
AM
PM
AM/PM
Communication Equipment
Qty
Item
Price
Days
Totals
Walkies - Motorola CP200
$10.00
Hand Mic
Extra Battery
6 Unit Charger with case
12 Unit Charger with case
In-House Walkie Insurance
$5.00
Lightweight Headset
$5.00
Surveillance Ear Piece
$5.00
Heavy Duty Headset
$10.00
Bullhorn
$15.00
Estimated Sub Total:
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