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Print out. Fill in. Fax in.
Fax: 203-696-0865


Reserve early to ensure availability
of the item(s) you want.
Reservation form
With this form, a tentative reservation will be created, subject to verification and confirmation.

Have you rented from us before?

Yes_____ No_____

List the item(s) you wish to reserve.
Please include item number.

Date________________

It is completely safe to fax your credit card information over a normal phone line, because it is inaccessible to internet 'hackers'.

1._________________________________________

2._________________________________________

Dates wanted:___________to___________

Dates wanted:___________to___________

Please list the phone number(s) where you can be reached so we can confirm your reservation(s).

Home___________________/Business___________________/Cellphone___________________

CREDIT CARD INFORMATION

First Name_____________________ MI____ Last Name________________________________

Company Name (if applicable)______________________________________________________

Address_____________________________City__________________State______Zip________

Visa_____/ MasterCard_____/ Discover_____Card Number______________________________

Expiration Date_____/_____Your Signature___________________________________________

NOTE: Your credit card will not be charged until the actual transaction has taken place. It must
be presented and processed at time of equipment pickup.