iPad Rental Request Form

iPad Rental Request Form

Contact Info
Name *

First Name Last Name
E-mail *
Phone Number

Area Code Phone Number
Delivery
Zip code for Shipping Estimate

Dates Requested
Start Reservation Date

Month Day Year
Date
End Reservation Date

Month Day Year
Date
Total Days
Total iPads requested
Total Cost

Optional Accessories
Optional Accessories

Extra sync/charging cable Bluetooth Keyboard Stylus Travel case for 20 or more units

Any other requests?
Notes

Payment

Totals

product

iPad Rental Deposit + One Day $ 74.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty: