Rental Form

Rental Form
Contact Info*
Customer Contact Email*
example@example.com
Shipping Name *
Shipping Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is Billing address the same as above?

YESNO
Billing Name
Billing Address

Street Address

Street Address Line 2

CityState

Zip Code
Shipping/ Receiving Hours*
Are you willing to receive outside of these hours for this instance*

YesNo
Equipment needed*
Request Type*

Emergency Customer Down (Will have expedite fee if after hours, weekend, or holiday)Emergency Need ASAP ( Next Business Day if after hours, weekend, or holiday)Customer Not Down but ASAP
{ShippingName} is agreeing to pay Blake and Pendleton expedite fee if this is an after-hours request. After-Hours is considered before 8am EST or after 5pm EST on any weekday or on a weekend day or Blake and Pendleton recognized holiday.
Please initial below to affirm you have read and agree to the above statement
Shipping type*
{billingName} is supplying a carrier of their choice and take full responsibility for any damage done after The unit(s) is loaded on the carrier's truck or trailer and/or until the unit is unloaded for the truck or trailer when it is returned.
Please initial below to affirm you have read and agree to the above statement

Vacuum
VACUUM HORSE POWER REQUIREMENT
Lbs. Hoist, Lift, or Crane must be to unload and load compressor
Our units are air cooled. Is there adequate ventilation?

YESNO
If adequate ventilation is not provided then it causes the units to overheat and shut down. This may cause service calls that will be the responsibility of the customer. This will be verified at startup by B & P technician.
VACUUM ELECTRICAL CONNECTION VOLTAGE
Breaker Size In Amps Required for Selection above
**If you do not have the required breaker size or need help please call 800-333-6650 and ask for the rental department We may have options available.
ARE HOSES REQUIRED

YESNO
Hose Options
IS WIRE REQUIRED

YESNO
WIRE LENGTH
WIRE LENGTH in 50ft increments 150ft Max

Compressor