Clone of Equipment Rental Order Form

HAULIN' WHEELS DUMPSTER RENTAL/ YOU FILL, WE HAUL SERVICE ORDER FORM

Located at: 920 W Chatham St, Cary, NC 27511
Appointment (Pickup)*
Customer Name*

First NameMiddle NameLast Name
Phone Number*
Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload Photo of ID (Driver License)*

Cancelof
Upload Photo of Insurance*

Cancelof
Insurance Name
Policy Number
Drop-off only $75Pick up only $75Drop-off and Pickup $150Customer Pickup/Return $0
Trailer Drop-off Address

Street Address

Street Address Line 2

CityState

Zip Code
Date/Time of Drop-Off

DayMonthYear
Date
Hour MinutesAM/PM Option
Trailer Pick up Address

Street Address

Street Address Line 2

CityState

Zip Code
Date/Time of Pick Up

DayMonthYear
Date
Hour MinutesAM/PM Option
7x14 Dump Trailer — 24 Hours — $1657x14 Dump Trailer — Weekend (Fri–Sun)— $3957x14 Dump Trailer — 7 Days — $990
Dump Service — Regular Materials — $150 haul fee + $75 per tonDump Service — Heavy Materials — $150 haul fee + $125 per ton
Total*
CONTACT US FOR ASSISTANCE:

919-298-1072 / HaulinWheels@outlook.com
Trailer Rental Agreement Form

Payment Amount*

USDTotal

Signature*

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HAULIN' WHEELS DUMPSTER RENTAL/ YOU FILL, WE HAUL SERVICE ORDER FORM