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Cancel Rental Request
Customer Information
Customer Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
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Rental Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Preferred Pickup Date
We will try to pick up on the date above, if possible, but date is subject to change. We will call to schedule and confirm
Preferred Pickup Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason For Cancellation
*
Please Select
Moving
Purchased My Own Machines
No Longer Needed
Financial Reasons
Unsatisfied With Service
Other
Additional Notes - Anything else we should know?
Please give us as much info as possible
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Confirm:
*
I understand the ARC technician will need access to the equipment, and someone 18 years or older must be present.
Confirm:
*
I understand billing continues until ARC has physically picked up the equipment.
Signature
*
Todays Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Request Status
*
Please Select
Cancel Requested
Submit
Submit
Should be Empty: