AV Rental Form
Name
*
First Name
Last Name
Business Name
*
Have you done business with us before?
Yes
No
How did you find us?
Please Select
Web
Friend
Other
Other
*
Referred By
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Phone Number
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Correspondence
*
E-mail
*
example@example.com
Fax
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Visual Impact Products
Video/Data Projection
High Definition HDMI Projector 3000+ Lumens
High Definition HDMI Projector 4000+ Lumens
High Definition HDMI Projector 5000+
LED/LCD Displays
Small 22"+
Medium 42"+
Large 65"+
Extra Large 80"+
Interactive - Touch
Digital Video Camera System - High Definition
Camera with Tripod
Camera Wireless Microphone
Projection Screens
60" Screen
80" Screen
100" Screen
120" Screen
Extra Large
Lighting
LED Leko
LED Up Light
Spot Light
Controller
Light Pole/Truss Hardware
Audio Impact Products
Presentations Sound System (Each system includes wired microphone and iPod connection.)
50 People or Less (Sm.)
50-200 People (Med.)
200-1000 People (Lg.)
Extra Large System
Sound System Upgrades
Subwoofer
Stage Monitors
Wireless Microphone (Lapels)
Wireless Microphones (Handheld)
Wireless Microphones (Head-worn)
Wired Microphones
Instrument Microphones
Microphone Stands
Presentation
Presentation Support
Video Conference - USB
Video Conference - IP
Laptop
Wireless PowerPoint Remote
Flip Chart - Easel
Podium - Lectern
Dates of Equipment Use
Name of Event or Facility
Name of Room
Setup Notes
Questions/Comments
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