Eastern Lift Truck Co., Inc.
Rental Request Form
Today's Date
*
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Month
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Day
Year
Date Picker Icon
From Account Manager (Email)
*
To Rental Manager / Coordinator(s)
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Allentown-Starr Zagrodnik
Berwick-Jon Knowles
Chantilly-Patti Deitzel
Dundalk-Kelley Geary
Hagerstown-Tonya Beitzel
Laurel-Kathy Drummond
Lincoln Park-Lauren Kadash
Newark-Bryan Meads
Maple Shade-Adam Molden
Montgomery-Nick Gniewosz
Piscataway-Lauren Kadash
Reading-Starr Zagrodnik
Upper Marlboro-Patti Deitzel
Vineland-Adam Molden
Warminster-Vince Tomes
York-Jenny Roof
Company Name
*
Customer Contact (First and Last Name)
*
First Name
Last Name
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shipping Address Same as Billing Address? (Click to copy)
Yes
Shipping Address (THIS IS WHERE THE RENTALS ARE NEEDED)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Customer Contact Phone Number
*
-
Area Code
Phone Number
Customer Contact E-mail
*
Order Details
# of Units Needed
*
Capacity / Capacities
*
Truck type
*
Please Select
C-1 3-Whl Sit-Down
C-1 3-Whl Stand
C-1 4-Whl Sit-Down
C-2 Order Selector
C-2 Single Reach
C-2 Double Reach
C-2 Turret
C-2 Other
C-3 Walkie
C-3 Walkie/Rider
C-3 Walkie/Stacker
C-3 Tugger
C-4 Cushion
C-5 Pneumatic
C-5 Container Handler
C-5 Reachstacker
C-6 Tugger
C-7 Rough Terr Forklift
C-7 Rough Terr Telehand
Aerial - Boom
Aerial - Scissors
Other
Fuel Type
*
Please Select
LPG
Diesel
Electric (12v)
Electric (24v)
Electric (36v)
Electric (48v)
Electric (72v)
Electric (80v)
Electric (Undecided)
Gasoline
Lithium-Ion
LPG Tank(s) Needed?
*
Yes
No
# of LPG Tanks Requested
Charger Needed?
*
Yes
No
Charger Input Voltage
Ex: 208v, 220/240v or 480v
Charger Phase (select one)
Single
Three
Not Sure
Confirm Charger Connector - Size and Color
Ex Size: SB175, SB350, etc. Ex Color: Red (usually 24v) Grey (usually 36v), Blue (usually 48v), Yellow, Green, Black, etc.
Max Lift / Platform Height
*
List in inches
Max Overall LOWERED Height
Important if customer has clearance concerns
Specific Free Lift Req?
Yes or No. If Yes, list free lift needed.
LBR Height Concern?
*
Yes or No. If Yes, list max height.
Carriage Width Concern?
Yes or No. If Yes, list needed width.
Sideshifter Required?
*
Yes
No
Sideshifting Fork Positioner
Attachment Info
*
Type and hydraulic needs.
Fork Length / Type
*
List dimensions / details.
Tires
*
Please Select
Cushion
Pneumatic (Air filled)
Pneumatic (Solid fill)
Special Non-Marking
Safety Items
Back-up alarm
Strobe light
Headlights
Rear Work Lights
Additional Notes
Delivery Details
Rental Unit(s) Need Delivered on THIS Date!
*
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Day
-
Month
Year
Date Picker Icon
1
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Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Dock or Ground Delivery?
*
Dock - Standard Height
Dock - Unusual Height (see add'l notes below)
Ground Delivery Required
Not Sure Yet
Expected Rental Duration
*
Please Select
Daily..............Less than 1 Week
Weekly..........Less than 1 Month
Monthly.........Approx 1 or 2 months
Monthly.........Approx 3 to 5 months
Long-Term....Approx 6 or more months
Additional Notes
Submit
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Print Form
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