Mazda Gulf Region Asset Request Form

REQUESTER
Contact Info*

First NameLast Name
E-mail*
DESTINATION
Event Name*
Business or Contact Name*
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date Requested*

MonthDayYear
Date
Date Needed*

MonthDayYear
Date
Asset Return Date*

MonthDayYear
Date
REQUESTER INFO
Dealership
Billing Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Activation Kit
- 10’ x 10’ branded tent (1)
- 10’ x 20’ branded tent (1)
- 8’ table with branded table cover (1)
- A-frame signage (2)
- 15’ feather banners (4)
Stanchions
- 8 Branded Stanchions
Choose One:*

Activation Kit with 10' x 10' Branded TentActivation Kit with 10' x 20' Branded TentStanchionsActivation Kit & Stanchions (10' x 10')Activation Kit & Stanchions (10' x 20')
Comments
Equipment Checkout
- Reservations are made on a first come, first serve basis.
- Equipment is being loaned with the understanding that it will be used responsibly. Recipient is responsible for any damages incurred or items lost while in their possession.
- Full activation kits only. No partials, with the exception of stanchions.
- The estimated charge for kit rental is $750 which include logistics and estimated shipping fees, actual cost may vary depending on shipment location.
- Maximum Rental Period is 10 days.
For questions or to confirm request, please contact Steven Pridgen. spridgen@mazdausa.com

For questions regarding shipping and logistics, please contact Doug Windus. dwindus@driveshop.com
By checking box, you agree to the terms of the loan.*

I agree.
Should be Empty: