Company Name
*
EX: Best Construction
Contract Number
*
EX: 12345-2
4 Digit Equipment Number
4 Digit Number on Equipment
Date
*
-
Month
-
Day
Year
Date
Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Agreement
*
I/We hereby instruct Superior Rents to schedule pick-up of above equipment. I/We understand upon arrival if above equipment is not ready to be picked up customer will be charged a pick-up fee.
Signature
*
Clear
Submit
Should be Empty: